DEPARTMENT 

of HEALTH

and HUMAN

SERVICES

Fiscal Year

2021

Justification of Estimates for 

Appropriations Committees

Substance Abuse and Mental Health 

Services Administration
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DEPARTMENT OF HEALTH AND HUMAN SERVICES

SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION

Table of Contents

Fiscal Year 2021 Budget Page

Letter from Assistant Secretary..................................................................................................... iii

Table of Contents........................................................................................................................... v

Organization Chart........................................................................................................................ vii

A. Performance Budget Overview

1. Introduction and Mission....................................................................................................1

2. Overview of Budget Request .............................................................................................2

3. Overview of Performance ..................................................................................................5

4. All Purpose Table (APT)....................................................................................................6

B. Budget Exhibits

1. Appropriations Language ...................................................................................................8

2. Language Analysis...........................................................................................................10

3. Amounts Available for Obligation ...................................................................................12

4. Summary of Changes .......................................................................................................13

5. Budget Authority by Activity...........................................................................................14

6. Authorizing Legislation....................................................................................................15

7. Appropriations History.....................................................................................................18

8. Appropriations Not Authorized by Law...........................................................................20

C. Mental Health

1. Mental Health Programs of Regional and National Significance ....................................25

2. Children’s Mental Health Services.................................................................................109

3. Project for Assistance in Transition from Homelessness...............................................115

4. Protection and Advocacy for Individuals with Mental Illness.......................................121

5. Certified Community Behavioral Health Clinic.............................................................126

6. Community Mental Health Services Block Grant..........................................................132

D. Substance Abuse Prevention

1. Substance Abuse Prevention Programs of Regional and National Significance............148

E. Substance Abuse Treatment

1. Substance Abuse Treatment Programs of Regional and National Significance ............183

2. State Opioid Response Grants........................................................................................256

3. Substance Abuse Prevention and Treatment Block Grant .............................................260
vi

F. Health Surveillance and Program Support

1. Health Surveillance ........................................................................................................273

2. Drug Abuse Warning Network (DAWN) ......................................................................281 

3. Performance and Quality Information Systems .............................................................284

4. Program Support.............................................................................................................289

5. Public Awareness and Support.......................................................................................291

G. Drug Control Budget...........................................................................................................295

H. Supplementary Tables 

1. Budget Authority by Object Class .................................................................................320

2. Salaries and Expenses......................................................................................................329

3. Detail of Full-Time Equivalent Employee (FTE)..............................................................331

4. GAO-IG-Act....................................................................................................................331

5. Detail of Positions ...........................................................................................................333

6. Programs Proposed for Elimination..................................................................................334

7. Physician’s Comparability Allowance Worksheet............................................................336

I. Significant Items................................................................................................................. 337

J. OPDIV Specific Gudiance...............................................................................................354
vii

 Organizational Structure: Substance Abuse and Mental Health Services Administration (SAMHSA) 

Organizational Structure: Substance Abuse and Mental Health Services Administration (SAMHSA) 
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 1

 Introduction

Prevention, treatment, and support to help people recover from mental and/or substance use

disorders are essential strategies for the health and prosperity of individuals, families,

communities, and the country. Individuals and families across the nation are struggling with the

consequences of living with mental and substance use disorders. In 2018, National Survey on

Drug Use and Health (NSDUH) data estimated 31.9 million Americans aged 12 or older, or 11.7

percent were current (past month) illicit drug users. In addition, an estimated 19.1 percent of adults

ages 18 and older had any mental illness in the past year (47.6 million) and 4.6 percent (11.4

million) of adults had serious mental illness. The nation can do better. SAMHSA has a unique 

responsibility to focus on these preventable and treatable problems, which, if unaddressed, lead to 

significant individual, societal, and economic consequences. 

 Mission

SAMHSA’s mission is to reduce the impact of substance misuse and mental illness on America’s 

communities. SAMHSA accomplishes this through providing leadership and resources –

programs, policies, information and data, funding, and personnel – to advance mental and 

substance use disorder prevention, treatment, and recovery services in order to improve individual, 

community, and public health.

 
2

Overview of Budget Request

The FY 2021 Budget Request is $5.74 billion, a decrease of $142 million from the FY 2020 Enacted 

Budget. The budget request aims to address critical national priorities including: combating the 

nation’s opioid crisis, addressing serious mental illness, developing and implementing strategies to 

prevent suicide, and expanding school-based mental health services. 

Key Budget Highlights

State Opioid Response Grants

The FY 2021 Budget Request is $1.59 billion, an increase of $85.0 million from the FY 2020 

Enacted. This program aims to address the opioid crisis by increasing access to medication-assisted 

treatment using the three FDA-approved medications for the treatment of opioid use disorder, 

reducing unmet treatment need, and reducing opioid overdose related deaths through the provision 

of prevention, treatment and recovery activities for opioid use disorder (OUD) (including 

prescription opioids, heroin and illicit fentanyl and fentanyl analogs). Funding was established to 

award grants to states and territories via formula. The program also includes a 15 percent set-aside 

for the 10 states with the highest mortality rates related to drug overdose deaths. The program also 

includes a $50 million set-aside for tribes. Given the varying nature of substance misuse across the 

United States, the budget continues to expand the use of State Opioid Response grants to include 

methamphetamine and other stimulants, giving states and tribes flexibility to address their unique 

community needs. States and communities across the country are dealing with rising rates of 

stimulant use and its negative health, social, and economic consequences, including some states 

which the latest data indicates are currently experiencing more overdose deaths from 

methamphetamine than opioids. SAMHSA continues to support the expansion of the use of this 

funding to provide states flexibility to address their greatest need. 

Community Mental Health Services Block Grant (MHBG)

The FY 2021 Budget Request is $757.6 million, which is $35 million above the FY 2020 Enacted. 

This funding continues to serve as a safety net for mental health services for some of the nation’s 

most vulnerable populations. By statute, MHBG funds must be used to address the needs of adults 

with serious mental illness (SMI) and children with serious emotional disturbances (SED). 

SAMHSA will maintain the ten percent set-aside for evidence-based programs that address the 

needs of individuals with early serious mental illness, including psychotic disorders. The set-aside 

helps reduce costs to society, as intervening early helps prevent deterioration of functioning in 

individuals experiencing a first episode of serious mental illness. The proposed increase of $35 

million will support state efforts to build much needed crisis systems to address the needs of 

individuals in mental health crisis in a high quality, expeditious manner. The development of these 

services will promote 24/7 access to well-trained mental health professionals in the time of acute 

mental health crisis. 

Certified Community Behavioral Health Clinics (CCBHCs) Expansion Grants

The FY 2021 Budget Request is $225.0 million, which is $25 million above the FY 2020 Enacted. 

While effective treatment and supportive services exist, many individuals with mental/substance 

use disorders do not receive the help they need. When they do try to access services, they may 

face significant delays and/or get connected to incomplete, disconnected, or uncoordinated care. 

Even people who receive some services, such as medication or psychotherapy, often do not have 
3

access to the complete range of supports they need, such as help to get them through a crisis, 

manage co-occurring physical health problems, find and sustain employment, and maintain a safe 

place to live in the community. 

Data from intake to most recent reassessment for individuals served in the CCBHC program 

demonstrate that as of January 2020, clients have 61.6 percent reduction in hospitalization and 

62.1 percent reduction in Emergency Department (ED) visits. Additionally, the data demonstrates 

that 15.2 percent had an increase in employment or started going to school, 30.4 percent increase 

in mental health functioning in everyday life.

This grant program expands service capacity of the organizations created by Congress in the 

Protecting Access to Medicare Act of 2014. The Act directed the creation of CCBHCs and support

for them to provide a comprehensive, coordinated range of services to their communities. Through 

this program, HHS has established criteria for clinics to be certified as CCBHCs. These criteria 

cover six areas that CCBHCs must address to be certified: (1) staffing; (2) availability and 

accessibility of services; (3) care coordination; (4) scope of services; (5) quality and other reporting; 

and (6) organizational authority. The CCBHC Expansion program is designed to increase access 

to and improve the quality of community mental and substance use disorder treatment services. 

CCBHCs funded under this program must provide access to services for individuals with serious 

mental illness (SMI) or substance use disorders (SUD), including opioid use disorders; children and 

adolescents with serious emotional disturbance (SED); and individuals with co-occurring mental 

and substance use disorders. SAMHSA expects that this program will improve the mental health 

of individuals across the nation by providing comprehensive community-based mental and 

substance use disorder services; treatment of co-occurring disorders; advance the integration of 

mental/substance use disorder treatment with physical health care; assimilate and utilize evidencebased practices on a more consistent basis, and promote improved access to high quality care. 

Project AWARE

The FY 2021 Budget Request is $125 million. This program, along with Healthy Transitions, is 

being requested in support of the Federal Commission on School Safety which is aimed at reducing 

the incidences of school violence across the country and increasing school-based mental health 

services. Project AWARE is comprised of the Project AWARE State Education Agency (SEA) 

grants and the Mental Health Awareness Training (MHAT) grants. Project AWARE SEA grants 

are awarded to State Education Agency/Authorities to promote comprehensive, coordinated, and 

integrated state efforts to make schools safer and increase access to mental health services. The 

MHAT grants train school personnel, emergency first responders, law enforcement, veterans, 

armed services members and their families to recognize the signs and symptoms of mental 

disorders, particularly serious mental illness (SMI) and/or serious emotional disturbances (SED). 

Project AWARE supports several strategies for addressing mental health in schools: supports for 

mental wellness in education settings, building awareness of mental health issues, and early 

intervention with coordinated supports. The program includes a focus on the specific needs 

affecting rural communities. These communities struggle with access to mental health services in 

schools and access to qualified health professionals to provide such services. 

Suicide Prevention Activities

The FY 2021 Budget Request is $93.0 million. SAMHSA’s budget requests is an increase of $3.0 

million to expand Zero Suicide initiatives to focus on adult suicide prevention and also allow 

communities and states to tailor strategies to prevent suicide in their local jurisdictions. Suicide is 
4

the 10th leading cause of death in the United States; according to most recent data, suicide deaths 

approximate deaths due to opioids, however, the fewer resources are dedicated to addressing suicide 

prevention. Suicide has been increasing in the United States, particularly in adults and older adults. 

The CDC (2018) has recently reported that suicide has risen nearly 30 percent during 1999-2016 

and has increased in 49 of the 50 states with 25 states experiencing increases over 30 percent.1 

With the rising rates of suicide among adults, particularly middle-aged and older adults, focusing 

on preventing suicide among adults is urgently required in order to reduce suicide nationally. The 

baby boomer generation has had higher than average rates of suicide throughout its lifecycle and is 

entering the stage of life that has historically had the highest rate of suicide. Without significant 

targeted intervention toward adults, the number of suicides in the United States could continue to 

increase. 

Suicide is a critical public health issue involving multiple psychological and social factors. Suicide 

rates have increased steadily for individuals of all ages. SAMHSA supports a full complement of 

programs which address the nation’s alarming rates of suicide. These include: the National 

Strategy for Suicide Prevention, which focuses on adult suicide prevention, the Garrett Lee Smith 

State an Tribal and Campus Suicide Programs, which address youth and young adult suicide, and 

the Tribal Training and Technical Assistance Center, which aims to provide needed training and 

TA to tribal communities to develop comprehensive suicide prevention strategies. Through the 

implementation of the 21st Century Cures Act, SAMHSA currently supports the Zero Suicide 

initiative aimed at reducing the rates of adult suicide prevention through the fundamental premise 

that suicide is preventable for individuals involved in the healthcare system. Since 2007, SAMHSA 

has been a partner with the U.S. Department of Veterans Affairs (VA) to enable use of the National 

Suicide Prevention Lifeline as a single entry point to help meet the special needs of veterans in 

crisis. Callers to SAMHSA’s 800-273-TALK number can press “1” to be connected to the VA’s 

Veterans Crisis Line. The number is also promoted to active duty personnel, reservists, and their 

families under the name “Military Crisis Line.” 

Assertive Community Treatment (ACT) for Adults with SMI

The FY 2021 Budget Request is $25.0 million. ACT is an evidence-based practice, designed as an 

integrated care approach to provide a comprehensive array of services, including medication 

management and other supportive services, directly rather than through referrals. Funding will 

support the needs of those living with SMI through technical assistance and evaluation activities. 

Assisted Outpatient Treatment (AOT) for Individuals with SMI

The FY 2021 Budget Request is $25.0 million. AOT is the practice of delivering outpatient 

treatment under court order to adults with SMI who meet specific criteria, such as a prior history of 

repeated hospitalizations or arrest. AOT involves petitioning local courts through a civil process 

to order individuals to enter and remain in treatment within the community for a specified period 

of time. Funding will help to identify evidence-based AOT practices that support improved 

outcomes, including outreach and engagement, clinical treatment and supportive services, and due 

process protections.

 1

Center for Disease Control and Prevention, Mortality and Morbidity Weekly Report; “Vital Signs: Trends in State

Suicide Rates-United States, 1999-2016 and Circu7mstances Contributing to Suicide -27 States, 2015, Stone, D.M et 

all, June 8, 2018. 
5

Overview of Performance

Consistent with the Government Performance and Results Modernization Act of 2010, the 

Substance Abuse and Mental Health Services Administration (SAMHSA) continues to refine its 

use of performance and evaluation data to measure impact and mitigate risk. Data-driven 

performance reviews help SAMHSA leadership analyze outcome data and learn the extent to which 

strategies work or need improvement. As impact is measured and reported, SAMHSA seeks to 

identify the conditions that foster success, address barriers, enable collaboration across programs, 

and promote overall efficiency. 

SAMHSA collects critical performance data on both output and outcome measures. Data on 

services programs include: diagnoses, abstinence from substance use, mental health functioning, 

overall physical health, criminal justice involvement, stable housing, social connectedness, and 

employment. Additionally, SAMHSA collects data on the number of people served, the number 

trained, and the number of training events held. 

SAMHSA also maintains its commitment to utilize these performance data to manage and monitor 

its robust portfolio of grants. In FY 2017, SAMHSA reconfigured its approach to uniform data 

collection with the successful launch and implementation of SAMHSA’s Performance 

Accountability and Reporting System (SPARS). This system provides a common data and 

reporting system for all SAMHSA discretionary grantees and allows for programmatic technical 

assistance on use of the data to enhance grantee performance monitoring and improve the quality 

of service delivery. In FY 2018, SAMHSA strengthened its internal evaluation ability through the 

creation of an Office of Evaluation in the Center for Behavioral Health Statistics and Quality. This 

Office partners with the National Mental Health and Substance Use Policy Laboratory to ensure 

that all SAMHSA programs are evaluated for effectiveness and that findings related to the most 

effective evidence-based practices to treat mental illness and substance use disorders are 

disseminated to the field. SAMHSA will continue its efforts to improve upon data collection to 

better inform service delivery. 
6

Substance Abuse and Mental Health Services Administration

All-Purpose Table

(Dollars in thousands)

FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

FY 2021 

President's 

Budget +/- 

FY 2020

Mental Health

Programs of Regional and National Significance....................................................... $453,222 $529,661 $509,793 -19,868 

Children's Mental Health Services............................................................................. 125,000 125,000 125,000 -

Set-Aside for Youth in Prodrome Phase of Psychosis (non-add).................... 12,500 12,500 12,500 -

Projects for Assistance in Transition from Homelessness.................................... 64,635 64,635 64,635 -

Protection and Advocacy for Individuals with Mental Illness............................. 36,146 36,146 14,146 -22,000 

Tribal Behavioral Health Formula Grants.................................................................. -- -- --

Community Mental Health Services Block Grant.................................................... 722,571 722,571 757,571 35,000

Budget Authority (non-add).................................................................................. 701,532 701,532 736,532

PHS Evaluation Funds (non-add)........................................................................ 21,039 21,039 21,039

Certified Community Behavioral Health Clinics....................................................... 150,000 200,000 225,000 25,000

Total, Mental Health ...................................................................................................... 1,551,574 1,678,013 1,696,145 18,132

Budget Authority (non-add)..................................................................................... 1,518,535 1,644,974 1,675,106 30,132

Prevention and Public Health Fund (non-add)................................................... 12,000 12,000 -- -12,000 

PHS Evaluation Funds (non-add)........................................................................... 21,039 21,039 21,039 -

Substance Abuse Prevention

Programs of Regional and National Significance....................................................... 205,469 206,469 96,985 -109,484 

Total, Substance Abuse Prevention............................................................................. 205,469 206,469 96,985 -109,484 

Substance Abuse Treatment -

Programs of Regional and National Significance....................................................... 458,531 479,677 364,677 -115,000 

State Targeted Response to the Opioid Crisis Grants ........................................... -- -- -- -

State Opioid Response Grants................................................................................... 1,500,000 1,500,000 1,585,000 85,000

Set-Aside for Tribes (non-add)........................................................................... 50,000 -

Substance Abuse Prevention and Treatment Block Grant.................................... 1,858,079 1,858,079 1,858,079 -

Budget Authority (non-add).................................................................................. 1,778,879 1,778,879 1,778,879 -

PHS Evaluation Funds (non-add)........................................................................ 79,200 79,200 79,200 -

Total, Substance Abuse Treatment............................................................................. 3,816,610 3,837,756 3,807,756 -30,000 

SAT Budget Authority (non-add)............................................................................. 3,735,410 3,756,556 3,728,556 -28,000 

SAT PHS Evaluation Funds (non-add).................................................................. 81,200 81,200 79,200 -2,000 

Health Surveillance and Program Support -

Health Surveillance and Program Support 126,258 126,258 106,885 -19,373 

Data Request and Publications User Fees............................................................... 1,500 1,500 1,500 --

Public Awareness and Support.................................................................................. 13,000 13,000 11,572 -1,428 

Performance and Quality Information Systems....................................................... 10,000 10,000 10,000 --

Behavioral Health Workforce Data and Development .......................................... 1,000 1,000 1,000 -

PHS Evaluation Funds (non-add)........................................................................ 1,000 1,000 1,000 -

Drug Abuse Warning Network.................................................................................. 10,000 10,000 10,000 -

PHS Evaluation Funds (non-add)........................................................................ -- 10,000 -

Total, Health Surveillance and Program Support.................................................... 161,758 161,758 140,957 -20,801 

HSPS Budget Authority (non-add).......................................................................... 128,830 128,830 97,004 -31,826 

HSPS PHS Evaluation Funds (non-add)............................................................... 31,428 31,428 42,453 11,025

Data Request and Publications User Fees(non-add).......................................... 1,500 1,500 1,500 -

TOTAL, SAMHSA Program Level............................................................................. 5,735,411 5,883,996 5,741,843 -142,153 

Nonrecurring Expenses Fund (NEF)........................................................................... 3,000 -- --

Less Funds from Other Sources: -

Prevention and Public Health Fund (non-add)................................................ -12,000 -12,000 -- 12,000

PHS Evaluation Funds........................................................................................... -133,667 -133,667 -142,692 -9,025 

Data Request and Publications User Fees.......................................................... -1,500 -1,500 -1,500 -

TOTAL, SAMHSA Budget Authority......................................................................... 5,588,244 5,736,829 5,597,651 -139,178 
7

SAMHSA

Budget Exhibits

Table of Contents

1. Appropriation Language ............................................................................................... 8

2. Language Analysis...................................................................................................... 10

3. Amounts Available for Obligation.............................................................................. 12

4. Summary of Changes.................................................................................................. 13

5. Budget Authority by Activity ..................................................................................... 14

6. Authorizing Legislation .............................................................................................. 15

7. Appropriations History ............................................................................................... 18

8. Appropriations Not Authorized by Law ..................................................................... 20
8

 

Appropriation Language

SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION

MENTAL HEALTH

For carrying out titles III, V, and XIX of the PHS Act with respect to mental health, and the 

Protection and Advocacy for Individuals with Mental Illness Act, [$1,644,974,000] 

$1,675,106,0000: Provided, [That of the funds made available under this heading, $68,887,000

shall be for the National Child Traumatic Stress Initiative: Provided further, ]That notwithstanding 

section 520A(f)(2) of the PHS Act, no funds appropriated for carrying out section 520A shall be 

available for carrying out section 1971 of the PHS Act: Provided further, That in addition to 

amounts provided herein, $21,039,000 shall be available under section 241 of the PHS Act to 

supplement funds otherwise available for mental health activities and to carry out subpart I of part 

B of title XIX of the PHS Act to fund section 1920(b) technical assistance, national data, data 

collection and evaluation activities, and further that the total available under this Act for section 

1920(b) activities shall not exceed 5 percent of the amounts appropriated for subpart I of part B of 

title XIX: Provided further, That $35,000,000 of the amounts appropriated for subpart I of part B 

of title XIX shall be available to support evidence-based crisis systems: Provided further, That up 

to 10 percent of the amounts made available to carry out the Children’s Mental Health Services 

program may be used to carry out demonstration grants or contracts for early interventions with 

persons not more than 25 years of age at clinical December 16, 2019 (3:33 p.m.) high risk of 

developing a first episode of psychosis: [Provided further, That section 520E(b)(2) of the PHS Act 

shall not apply to funds appropriated in this Act for fiscal year 2021: Provided further, That States 

shall expend at least 10 percent of the amount each receives for carrying out section 1911 of the 

PHS Act to support evidence based programs that address the needs of individuals with early serious 

mental illness, including psychotic disorders, regardless of the age of the individual at onset:]

Provided further, That [$200,000,000] $225,000,000 shall be available until September 30, [2022] 

2023 for grants to communities and community organizations who meet criteria for Certified 

Community Behavioral Health Clinics pursuant to section 223(a) of Public Law 113–93: Provided 

further, That none of the funds provided for section 1911 of the PHS Act shall be subject to section 

241 of such Act: Provided further, That of the funds made available under this heading,

[$19,000,000] $25,000,000 shall be to carry out section 224 of the Protecting Access to Medicare 

Act of 2014 (Public Law 113–93; 42 U.S.C. 290aa 22 note).

SUBSTANCE ABUSE TREATMENT

For carrying out titles III and V of the PHS Act with respect to substance abuse treatment 

and title XIX of such Act with respect to substance abuse treatment and prevention, and the

SUPPORT for Patients and Communities Act, [$3,756,556,000] $3,728,556,000: Provided, That

[$1,500,000,000] $1,585,000,000 shall be for State Opioid Response Grants for carrying out 

activities pertaining to opioids and stimulants undertaken by the State agency responsible for 

administering the substance abuse prevention and treatment block grant under subpart II of part B 

of title XIX of the PHS Act (42 U.S.C. 300x–21 et seq.): Provided further, That of such amount 

$50,000,000 shall be made available to Indian Tribes or tribal organizations: Provided further, That 

15 percent of the remaining amount shall be for the States with the highest mortality rate related to 
9

opioid use disorders: Provided further, That of the amounts provided for State Opioid Response 

Grants not more than 2 percent shall be available for Federal administrative expenses, training, 

technical assistance, and evaluation: Provided further, That of the amount not reserved by the 

previous three provisos, the Secretary shall make allocations to States, territories, and the District 

of Columbia according to a formula using national survey results that the Secretary determines are 

the most objective and reliable measure of drug use and drug-related deaths: [Provided further, 

That the Secretary shall submit the formula methodology to the Committees on Appropriations of 

the House of Representatives and the Senate not less than 15 days prior to publishing a Funding 

Opportunity Announcement:] Provided further, That prevention and treatment activities funded 

through such grants may include education, treatment (including the provision of medication), 

behavioral health services for individuals in treatment programs, referral to treatment services, 

recovery support, and medical screening associated with such treatment: Provided further, That 

each State, as well as the District of Columbia, shall receive not less than $4,000,000: Provided 

further, That in addition to amounts provided herein, [the following amounts] $79,200,000 shall be 

available under section 241 of the PHS Act [: (1) $79,200,000] to supplement funds otherwise 

available for substance abuse treatment activities to carry out subpart II of part B of title XIX of 

the PHS Act to fund section 1935(b) technical assistance, national data, data collection and 

evaluation activities, and further that the total available under this Act for section 1935(b) activities 

shall not exceed 5 percent of the amounts appropriated for subpart II of part B of title XIX [; and 

(2) $2,000,000 to evaluate substance abuse treatment programs]: Provided further, That none of the 

funds provided for section 1921 of the PHS Act or State Opioid Response Grants shall be subject 

to section 241 of such Act.

SUBSTANCE ABUSE PREVENTION

For carrying out titles III and V of the PHS Act with respect to substance abuse prevention, 

[$206,469,000] $96,985,000.

HEALTH SURVEILLANCE AND PROGRAM SUPPORT

For program support and cross-cutting activities that supplement activities funded under the 

headings ‘‘Mental Health’’, ‘‘Substance Abuse Treatment’’, and ‘‘Substance

Abuse Prevention’’ in carrying out titles III, V, and XIX of the PHS Act and the Protection and 

Advocacy for Individuals with Mental Illness Act in the Substance Abuse and Mental Health 

Services Administration, [$128,830,000] $97,004,000: Provided, That in addition to amounts 

provided herein, [$31,428,000] $42,453,000 shall be available under section 241 of the PHS Act to 

supplement funds available to carry out national surveys on drug abuse and mental health, to collect 

and analyze program data, and to conduct public awareness and technical assistance activities: 

Provided further, That, in addition, fees may be collected for the costs of publications, data, data 

tabulations, and data analysis completed under title V of the PHS Act and provided to a public or 

private entity upon request, which shall be credited to this appropriation and shall remain available 

until expended for such purposes: Provided further, That amounts made available in this Act for 

carrying out section 501(o) of the PHS Act shall remain available through September 30, [2021]

2022: Provided further, That funds made available under this heading may be used to supplement 

program support funding provided under the headings ‘‘Mental Health’’, ‘‘Substance Abuse 

Treatment’’, and ‘‘Substance Abuse Prevention’’.
10

Language Analysis

Language Provision Explanation

For carrying out titles III, V, and XIX of the PHS 

Act with respect to mental health, and the Protection 

and Advocacy for Individuals with Mental Illness 

Act $1,675,106,000: 

Identifies the purpose for which funds 

can be used for mental health. Language 

regarding the National Child Traumatic 

Stress Initiative is removed because a 

separate funding proviso is unnecessary 

and duplicative. 

Provided further, That in addition to amounts 

provided herein, $21,039,000 shall be available 

under section 241 of the PHS Act to supplement 

funds otherwise available for mental health 

activities and to carry out subpart I of part B of title 

XIX of the PHS Act to fund section 1920(b) 

technical assistance, national data, data collection 

and evaluation activities, and further that the total 

available under this Act for section 1920(b) 

activities shall not exceed 5 percent of the amounts 

appropriated for subpart I of part B of title XIX: : 

Provided further, That $35,000,000 of the amounts 

appropriated for subpart I of part B of title XIX shall 

be available to support evidence-based crisis 

systems:

Sets the amount of Public Health Service 

Evaluation Fund dollars allocated to 

supplement the budget authority for 

programs for mental health activities and 

programs authorized under title XIX as 

well as under titles III and V. In addition, 

set amount for evidence-based crisis 

systems.

[Provided further, That section 520E(b)(2) of the 

PHS Act shall not apply to funds appropriated in this 

Act for fiscal year 2021: Provided further, That 

States shall expend at least 10 percent of the amount 

each receives for carrying out section 1911 of the 

PHS Act to support evidence-based programs that 

address the needs of individuals with early serious 

mental illness, including psychotic disorders, 

regardless of the age of the individual at onset:]

Language is removed because a separate 

funding proviso is unnecessary and 

duplicative. 
11

Language Analysis (continued)

Provided further, That in addition to amounts 

provided herein, the following amounts $79,200,000 

shall be available under section 241 of the PHS Act 

to supplement funds otherwise available for 

substance abuse treatment activities and [: (1) 

$79,200,000] to carry out subpart II of part B of title 

XIX of the PHS Act to fund section 1935(b) 

technical assistance, national data, data collection 

and evaluation activities, and further that the total 

available under this Act for section 1935(b) 

activities shall not exceed 5 percent of the amounts 

appropriated for subpart II of part B of title XIX[; 

and (2) $2,000,000 to evaluate substance abuse 

treatment programs]: 

Sets the amount of Public Health Service 

Evaluation Fund dollars allocated to 

supplement the budget authority 

available for programs and activities 

authorized under title XIX, titles III and 

V, and substance abuse treatment 

activities. 
12

Amounts Available for Obligation

(Whole dollars)

FY 2019

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

General Fund Discretionary Appropriation:

Appropriation............................................................. 

 

$5,596,829,000 

 

$5,736,829,000 

 

$5,597,651,000 

Across-the-board reductions....................................... 

 --

-

 

---

 --

-

Subtotal, Appropriation............................................ 

 

5,596,829,000 

 

5,736,829,000 

 

5,597,651,000 

Rescission................................................................... 

 --

-

 

---

 --

-

Subtotal, adjusted appropriation................................. 

 

5,596,829,000 

 

5,736,829,000 

 

5,597,651,000 

Transfer Out to ACF................................................... 

 

(8,585,688)

 

---

 --

-

Subtotal, adjusted appropriation................................. 

 

5,588,243,312 

 

5,736,829,000 

 

5,597,651,000 

Total, Discretionary Appropriation..................... 

 

5,588,243,312 

 

5,736,829,000 

 

5,597,651,000 

Mandatory Appropriation:

Transfer from the Prevention and Public Health Funds... 

 

12,000,000 

 

12,000,000 

 --

-

Subtotal, adjusted mandatory appropriation................ 

 

12,000,000 

 

12,000,000 

 --

-

Offsetting collections from:

Federal Source.............................................................. 

 

133,667,000 

 

133,667,000 

 

142,692,000 

Data Request and Publications User Fees....................... 

 

1,500,000 

 

1,500,000 

 

1,500,000 

Unobligated balance, start of year................................... 

 --

-

 

---

 --

-

Unobligated balance, end of year.................................... 

 --

-

 

---

 --

-

Unobligated balance, lapsing........................................... 

 --

-

 

---

 --

-

Total obligations........................................................ 

 

$5,735,410,312 

 

$5,883,996,000 

 

$5,741,843,000 
13

Summary of Changes

(Whole dollars)

$5,736,829,000

 5,736,829,000

$5,597,651,000

 5,597,651,000

-$139,178,000

FY 2020 FY 2021 FY 2021

FY 2021

+/- 

FY 2021

FY 2021

+/- 

FY 2021

Final PB FTE PB BA FTE BA

Increases:

A. Built-in:

1. Annualization of 2020 commissioned corps pay increase... $6,324,007 $ $6,687,232 --- +363,225

2. Annualization of 2020 civilian pay increase........................... 87,816,536 0 89,035,370 --- +1,218,834

Subtotal, Built-in Increases...................................................... 94,140,543 --- 95,722,602 --- +1,582,059

A. Program:

1. Drug Free Communities............................................................. --- --- --- --- ---

2. Mental Health............................................................................. 1,644,974,000 --- 1,675,106,000 --- +30,132,000

3. Substance Abuse Prevention................................................... 206,469,000 --- --- --- -206,469,000

Subtotal, Built-in Increases...................................................... 1,851,443,000 0 1,675,106,000 --- -176,337,000

Total Increases......................................................................... --- --- --- --- -174,754,941

Decreases:

A. Built-in:

1. Absorption of built-in increases ............................................. --- -1,582,059

Subtotal, Built-in Decreases.................................................... --- -1,582,059

B. Program:

1. Health Surveillance and Program Support.............................. 128,830,000 --- 97,004,000 --- -31,826,000

2. Mental Health............................................................................. --- --- --- --- ---

3. Substance Abuse Prevention................................................... --- --- 96,985,000 --- +96,985,000

4.Substance Abuse Treatment .................................................... 3,756,556,000 --- 3,728,556,000 --- -28,000,000

Subtotal, Program Decreases.................................................. 3,885,386,000 --- 3,922,545,000 --- +37,159,000

Total Decreases....................................................................... --- --- --- --- +35,576,941

Net Change............................................................................ --- $--- $--- $--- -$139,178,000

(Obligations)..................................................................................................................................................................................

Net Change.................................................................................................................................................................................

2020 Enacted..................................................................................................................................................................................

2021 President's Budget...............................................................................................................................................................

Total estimated budget authority...............................................................................................................................................

(Obligations)..................................................................................................................................................................................

Total estimated budget authority...............................................................................................................................................
14

Budget Authority by Activity

(Dollars in thousands)

FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

Mental Health

Programs of Regional and National Significance............................................. $453,222 $529,661 $509,793

Children's Mental Health Services............................................................... 125,000 125,000 125,000

Set-Aside for Youth in Prodrome Phase of Psychosis (non-add)................................... 12,500 12,500 12,500

Projects for Assistance in Transition from Homelessness.............................. 64,635 64,635 64,635

Protection and Advocacy for Individuals with Mental Illness.......................... 36,146 36,146 14,146

Tribal Behavioral Health Formula Grants...................................................... -- -- --

Community Mental Health Services Block Grant.......................................... 722,571 722,571 757,571

Budget Authority (non-add)................................................................................................. 701,532 701,532 736,532

PHS Evaluation Funds (non-add)....................................................................................... 21,039 21,039 21,039

Certified Community Behavioral Health Clinics............................................. 150,000 200,000 225,000

Total, Mental Health ................................................................................ 1,551,574 1,678,013 1,696,145

Substance Abuse Prevention

Programs of Regional and National Significance............................................. 205,469 206,469 96,985

Total, Substance Abuse Prevention.......................................................... 205,469 206,469 96,985

Substance Abuse Treatment

Programs of Regional and National Significance............................................. 458,531 479,677 364,677

State Targeted Response to the Opioid Crisis Grants .................................... -- -- --

State Opioid Response Grants..................................................................... 1,500,000 1,500,000 1,585,000

Set-Aside for Tribes (non-add).......................................................................................... 50,000

Substance Abuse Prevention and Treatment Block Grant.............................. 1,858,079 1,858,079 1,858,079

Budget Authority (non-add)................................................................................................. 1,778,879 1,778,879 1,778,879

PHS Evaluation Funds (non-add)....................................................................................... 79,200 79,200 79,200

Total, Substance Abuse Treatment........................................................... 3,816,610 3,837,756 3,807,756

Health Surveillance and Program Support

Health Surveillance and Program Support 126,258 126,258 106,885

Data Request and Publications User Fees.................................................... 1,500 1,500 1,500

Public Awareness and Support.................................................................... 13,000 13,000 11,572

Performance and Quality Information Systems............................................. 10,000 10,000 10,000

Behavioral Health Workforce Data and Development .................................. 1,000 1,000 1,000

PHS Evaluation Funds (non-add)....................................................................................... 1,000 1,000 1,000

Drug Abuse Warning Network.................................................................... 10,000 10,000 10,000

PHS Evaluation Funds (non-add)....................................................................................... -- 10,000

Total, Health Surveillance and Program Support...................................... 161,758 161,758 140,957

TOTAL, SAMHSA Program Level............................................................................................ 5,735,411 5,883,996 5,741,843

Nonrecurring Expenses Fund (NEF).......................................................................................... 3,000 --

Less Funds from Other Sources:

Prevention and Public Health Fund (non-add)............................................................... -12,000 -12,000 --

PHS Evaluation Funds.......................................................................................................... -133,667 -133,667 -142,692 

Data Request and Publications User Fees......................................................................... -1,500 -1,500 -1,500 

TOTAL, SAMHSA Budget Authority........................................................................................ 5,588,244 5,736,829 5,597,651

FTEs 491 606 615
15

Substance Abuse and Mental Health Services Administration

Authorizing Legislation

(Dollars in Thousands)

Activity

FY 2020 

Amount 

Authorized

FY 2020 

Amount 

Appropriated

FY 2021 

Amount 

Authorized

FY 2021 

President's 

Budget

1. Grants for the Benefit of Homeless $ 41,304,000 $ 36,386,000 $ 41,304,000 $ 36,386,000

PHS Act, Section 506...............................................

2. Residential Treatment Programs for Pregnant and 

Postpartum Women

 $ 29,931,000 $ 31,931,000 $ 29,931,000 $ 31,931,000 

PHS Act, Section 508...............................................

3. Priority Substance Abuse Treatment Needs of 

Regional and National Significance

$ 333,806,000 $ 479,677,000 $ 333,806,000 $ 364,677,000

PHS Act, Section 509...............................................

4. Substance Abuse Treatment Services for Children 

and Adolescents

$ 29,605,000 $ 29,605,000 $ 29,605,000 $ 29,605,000

PHS Act, Section 514...............................................

5. Priority Substance Abuse Prevention Needs of 

Regional and National Significance

$ 211,148,000 $ 206,469,000 $ 211,148,000 $ 96,985,000

PHS Act, Section 516..................................................

6. Sober Truth on Preventing Underage Drinking $ 7,000,000 $ 9,000,000 $ 7,000,000 $ 9,000,000

PHS Act, Section 519B...............................................

7. Priority Mental Health Needs of Regional and 

National Significance

$ 394,550,000 $ 441,774,000 $ 394,550,000 $ 415,906,000

PHS Act, Section 520A...............................................

8. Suicide Prevention Technical Assistance Center $ 5,988,000 $ 7,988,000 $ 5,988,000 $ 7,988,000

PHS Act, Section 520C...............................................

9. Youth Suicide Early Intervention and Prevention 

Strategies

$ 30,000,000 $ 35,427,000 $ 30,000,000 $ 35,427,000

PHS Act, Section 520E...............................................

10. Mental Health and Substance Use Disorder 

Services on Campus

$ 7,000,000 $ 6,488,000 $ 7,000,000 $ 6,488,000

PHS Act, Section 520E-2............................................

11. National Suicide Prevention Lifeline Program $ 7,198,000 $ 19,000,000 $ 7,198,000 $ 19,000,000

PHS Act, Section 520E-3............................................
16

Substance Abuse and Mental Health Services Administration

Authorizing Legislation

(Dollars in Thousands)

Activity

FY 2020 

Amount 

Authorized

FY 2020 

Amount 

Appropriated

FY 2021 

Amount 

Authorized

FY 2021 

President's 

Budget

12. Grants for Jail Diversion Programs $ 4,269,000 $ 6,269,000 $ 4,269,000 $ 9,269,000

PHS Act, Section 520G...............................................

13. Mental Health Awareness Training $ 14,693,000 $ 22,963,000 $ 14,693,000 $ 21,963,000

PHS Act, Section 520J................................................

14. Promoting Integration of Primary and Behavioral 

Health Care

$ 51,878,000 $ 51,868,000 $ 51,878,000 $ -

PHS Act, Section 520K...............................................

15. Adult Suicide Prevention $ 30,000,000 $ 18,200,000 $ 30,000,000 $ 21,200,000

PHS Act, Section 520L...............................................

16. Assertive Community Treatment Grant Program $ 5,000,000 $ 7,000,000 $ 5,000,000 $ 25,000,000

PHS Act, Section 520M..............................................

17. Projects for Assistance in Transition From 

Homelessness

$ 64,635,000 $ 64,635,000 $ 64,635,000 $ 64,635,000

PHS Act, Section 535(a).............................................

18. First Responder Training $ 36,000,000 $ 41,000,000 $ 36,000,000 $ 41,000,000

PHS Act, Section 546..................................................

19. Building Communities of Recovery $ 5,000,000 $ 8,000,000 $ 5,000,000 $ 8,000,000

PHS Act, Section 547..................................................

20. Community Mental Health Services for Children 

with Serious Emotional Disturbances

$ 119,026,000 $ 125,000,000 $ 119,026,000 $ 125,000,000

PHS Act, Section 565(f)(1)..........................................

21. Grants to Address the Problems of Persons Who 

Experience Violence Related Stress

$ 63,887,000 $ 68,887,000 $ 63,887,000 $ 68,887,000

PHS Act, Section 582..................................................
17

Substance Abuse and Mental Health Services Administration

Authorizing Legislation

(Dollars in Thousands)

Activity

FY 2020 

Amount 

Authorized

FY 2020 

Amount 

Appropriated

FY 2021 

Amount 

Authorized

FY 2021 

President's 

Budget

22. Community Mental Health Services Block Grants $ 532,571,000 $ 722,571,000 $ 532,571,000 $ 757,571,000

PHS Act, Section 1911................................................

23. Substance Abuse Prevention and Treatment Block 

Grants

$ 1,858,079,000 $1,858,079,000 $ 1,858,079,000 $ 1,858,079,000

PHS Act, Section 1921................................................

24. Assisted Outpatient Treatment Grant Program for 

Individuals With SMI

$ 19,000,000 $ 19,000,000 $ 18,000,000 $ 25,000,000

Section 224 of the Protecting Access to Medicare Act 

of 2014.........................................................

25. Protection and Advocacy for Individuals with 

Mental Illness*

$ - $ 36,146,000 $ - $ 14,146,000

Section 117 of the Protection and Advocacy of 

Mentally Ill Individuals Act of 1986.....................

26. Heath Surveillance Permanent $ 126,258,000 Permanent $ 106,885,000

PHS Act, Section 501, 505...........................................

27. Public Awareness and Support Indefinite $ 13,000,000 Indefinite $ 11,572,000 

PHS Act, Section 501, 509, 516, 520A..........................

28. Performance and Quality Improvement Systems Indefinite $ 10,000,000 Indefinite $ 10,000,000 

PHS Act, Section 501, 509, 516, 520A..........................

* Sunset date: 2003
18

Substance Abuse and Mental Health Services Administration

Appropriation History Table

(Whole dollars)

Budget Estimate 

to Congress

House 

Allowance

Senate 

Allowance Appropriation

FY 2010

General Fund Appropriation:

Base P.L. 111-117......................... $3,393,882,000 $3,429,782,000 $3,419,438,000 $3,431,116,000 /1

Subtotal......................................... $3,393,882,000 $3,429,782,000 $3,419,438,000 $3,431,116,000

FY 2011

General Fund Appropriation:

Base P.L. 112-10........................... $3,541,362,000 $3,565,360,000 $3,576,184,000 $3,386,311,000

Subtotal......................................... $3,541,362,000 $3,565,360,000 $3,576,184,000 $3,386,311,000

FY 2012

General Fund Appropriation:

Base P.L. 112-74........................... $3,386,903,000 $3,096,914,000 $3,354,637,000 $3,347,020,000 /2

Subtotal......................................... $3,386,903,000 $3,096,914,000 $3,354,637,000 $3,347,020,000

FY 2013

General Fund Appropriation:

Base S.R. 112-176 ....................... $3,151,508,000 --- $3,472,213,000 $3,172,154,778 /3

Subtotal......................................... $3,151,508,000 --- $3,472,213,000 $3,172,154,778

FY 2014

General Fund Appropriation:

Base S.R. 113-071......................... $3,347,951,097 --- $3,529,944,000 $3,434,935,000 /4

Subtotal......................................... $3,347,951,097 --- $3,529,944,000 $3,434,935,000

FY 2015

General Fund Appropriation:

Base P.L. 113-235......................... $3,297,669,000 --- $3,431,878,000 $3,474,045,000 /5

Subtotal......................................... $3,297,669,000 --- $3,431,878,000 $3,474,045,000

FY 2016

General Fund Appropriation:

Base P.L. 114-113......................... $3,395,663,000 $3,642,710,000 $3,314,817,000 $3,634,269,000 /6

Subtotal......................................... $3,395,663,000 $3,642,710,000 $3,314,817,000 $3,634,269,000

FY 2017

General Fund Appropriation:

21st Century Cures Act.............. $500,000,000 /7

Base P.L. 115-31........................... $3,488,783,000 $4,211,603,000 $3,739,577,000 $3,611,003,000 /8

Subtotal......................................... $3,488,783,000 $4,211,603,000 $3,739,577,000 $4,111,003,000

Appropriation History Table
19

Substance Abuse and Mental Health Services Administration

Appropriation History Table Cont’d

(Whole dollars)

Appropriation History Table (cont'd)

Budget 

Estimate to

Congress

House 

Allowance

Senate 

Allowance Appropriation

FY 2018

General Fund Appropriation:

21st Century Cures Act.............. $500,000,000 /7

Base P.L. 115-141......................... $3,770,668,000 $4,193,936,000 $4,279,092,000 $4,513,327,000 /9

Subtotal......................................... $3,770,668,000 $4,193,936,000 $4,279,092,000 $5,013,327,000

FY 2019

General Fund Appropriation:

Base P.L. 115-245......................... $3,425,887,000 $5,319,561,000 $5,592,827,000 $5,596,829,000 /10

Subtotal......................................... $3,425,887,000 $5,319,561,000 $5,592,827,000 $5,596,829,000

FY 2020

General Fund Appropriation:

Base............................................... $5,534,908,000 $5,870,996,000 $5,856,496,000 $5,736,829,000 /11

Subtotal......................................... $5,534,908,000 $5,870,996,000 $5,856,496,000 $5,736,829,000

FY 2021

General Fund Appropriation:

Base............................................... $5,597,651,000 --- --- --- /12

Subtotal......................................... $5,597,651,000 --- --- ---

1/ Reflects a $508 thousand transfer to HHS.

2/ Reflects a 0.189 percent across-the-board Rescission from the P.L. 112-74, and $953,809 Ryan White transfer.

3/ Reflects the annualized level provided by the continuing resolution.

4/ Reflects the whole year appropriation.

5/ Reflects the whole year appropriation.

6/ Reflects the whole year appropriation.

7/ Reflects the additional amount provided to the Secretary of Health and Human Services to carry out the authorizations in the 21st 

Century Cures Act

(Public Law 114–67), at a rate for operations of $500,000,000."

8/ Reflects the whole year appropriation.

9/ Reflects the Annualized Continuing Resolution.

10/ Reflects the whole year appropriation.

11/ Reflects the whole year appropriation.

12/ Reflects the whole year appropriation.
20

 Substance Abuse and Mental Health Services Administration

Appropriations Not Authorized by Law

(Whole dollars)

Program

Last Year of 

Authorization

Authorization 

Level

Appropriation 

in 

Last Year of 

Authorization

Appropriation 

in FY 2020

Protection and Advocacy for Individuals with Mental Illness Act

P.L. 99-319, Sec. 117..................................... 2003 $ 19,500,000 $ 36,146,000 $ 36,146,000

TOTAL, SAMHSA Budget Authority....... $ 19,500,000 $ 36,146,000 $ 36,146,000
21

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22

SAMHSA

Mental Health

Table of Contents

1. Mental Health Appropriation............................................................................................ 24

2. Programs of Regional and National Significance (PRNS)............................................... 25

a) National Child Traumatic Stress Network............................................................ 26

b) Project AWARE and Mental Health Awareness Training ................................... 30

c) Healthy Transitions............................................................................................... 34

d) Children and Family Programs............................................................................. 37

e) Consumer and Family Network Grants ................................................................ 39

f) Project LAUNCH.................................................................................................. 41

g) Mental Health System Transformation and Health Reform ................................. 45

h) Primary and Behavioral Health Care Integration.................................................. 48

i) Suicide Prevention Programs................................................................................ 51

i. National Strategy for Suicide Prevention ....................................................... 52

ii. Garrett Lee Smith Youth Suicide Prevention – State/Tribal and Campus...... 54

iii. Garrett Lee Smith Suicide Prevention Resource Center................................. 56

iv. Suicide Lifeline............................................................................................... 58

v. American Indian/Alaska Native Suicide Prevention Initiative....................... 60

a. Homelessness Prevention Programs..................................................................... 63

b. Minority AIDS and HIV/AIDS Education ........................................................... 66

c. Criminal and Juvenile Justice Programs............................................................... 69

d. Practice Improvement and Training...................................................................... 72

e. Consumer and Consumer-Supporter TA Centers................................................. 74

f. Disaster Response ................................................................................................. 76

g. Seclusion and Restraint......................................................................................... 79

h. Assertive Community Treatment for Individuals with Serious Mental Illness .... 80

i. Assisted Outpatient Treatment for Individuals with Serious Mental Illness........ 83

j. Tribal Behavioral Health Grants........................................................................... 89

k. Minority Fellowship Program............................................................................... 92

l. Infant and Early Childhood Mental Health........................................................... 94

m. Comprehensive Opioid Recovery Centers............................................................ 97

3. PRNS Mechanism Table Summary .................................................................................. 99

4. PRNS Mechanism Table by Program, Project, and Activity.......................................... 100

5. Grant Awards Table........................................................................................................ 108

6. Children's Mental Health Services.................................................................................. 109

7. Projects for Assistance in Transition from Homelessness (PATH)................................ 115

8. Protection and Advocacy for Individuals with Mental Illness (PAIMI)......................... 121

9. Certified Community Behaviroal Health Clinic ............................................................. 126

10. Community Mental Health Services Block Grant (MHBG)........................................... 132
23

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24

Mental Health Appropriation

(Dollars in thousands)

FY 2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

President's 

Budget +/-

FY 2020 

Enacted

Programs of Regional and National 

Significance......................... 453,222 529,661 509,793 -19,868

Prevention and Public Health Fund (nonadd).....................

 

12,000 

 

12,000 - -12,000

Children's Mental Health 

Services.................................................. 125,000 125,000 125,000 ---

Projects for Assistance in Transition From 

Homelessness........ 64,635 64,635 64,635 ---

Protection and Advocacy For Individuals with Mental 

Illness. 36,146 36,146 14,146 -22,000

Certified Community Behavioral Health 

Clinics............................ 150,000 200,000 225,000 25,000

Community Mental Health Services Block 

Grant......................... 722,571 722,571 757,571 35,000

PHS Evaluation Funds (nonadd)............................................. 21,039 21,039 21,039 ---

Total, Mental 

Health......................................................................... $1,551,574 $1,678,013 $1,696,145 $18,132

The Mental Health FY 2021 President’s Budget is $1.696 billion, an increase of $18.1 million from 

the FY 2020 Enacted level. The request includes $1.675 billion in Budget Authority and $21.0 

million in Public Health Service (PHS) Evaluation funds.
25

Programs of Regional and National Significance (PRNS)

Mental Health Appropriation

(Dollars in thousands)

FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

FY 2021 

President's 

Budget +/- 

FY 2020

Capacity

National Child Traumatic Stress Network......................... 63,887 68,887 68,887 -

Project AWARE................................................................. 71,001 102,001 103,001 1,000

Project AWARE: State Grants(non-add)......................... 61,001 92,001 83,001

Project AWARE: Civil Unrest(non-add)......................... 10,000 10,000 10,000

Project AWARE: Rural (non-add)................................... -- -- 10,000 10,000

Mental Health Awareness Training................................... 20,963 22,963 21,963 -1,000

Healthy Transitions........................................................... 25,951 28,951 30,951 2,000

Children and Family Programs........................................... 7,229 7,229 7,229 -

Consumer and Family Network Grants............................. 4,954 4,954 4,954 -

Project LAUNCH.............................................................. 23,605 23,605 23,605 -

MH System Transformation and Health Reform.............. 3,779 3,779 3,779 -

Primary and Behavioral Health Care Integration................ 43,438 49,877 - -49,877

Suicide Prevention Programs.............................................. 74,034 90,034 93,034 3,000

National Strategy for Suicide Prevention........................ 11,200 18,200 21,200 3,000

Zero Suicide (non-add)................................................ 9,200 16,200 19,200 3,000

Zero Suicide AI/AN(non-add)................................ 2,200 2,200 2,200 -

All Other National Strategy for Suicide Prevention 

(non-add) 2,000 2,000 2,000 -

GLS - Youth Suicide Prevention - States......................... 35,427 35,427 35,427 -

Budget Authority (non-add)......................................... 23,427 23,427 35,427 12,000

Prevention and Public Health Fund (non-add)............ 12,000 12,000 - -12,000

GLS - Youth Suicide Prevention - Campus..................... 6,488 6,488 6,488 -

GLS - Suicide Prevention Resource Center.................... 5,988 7,988 7,988 -

Suicide Lifeline................................................................ 12,000 19,000 19,000 -

AI/AN Suicide Prevention Initiative................................. 2,931 2,931 2,931 -

Homelessness Prevention Programs................................... 30,696 30,696 30,696 -

Minority AIDS.................................................................. 9,224 9,224 9,224 -

Criminal and Juvenile Justice Programs............................. 4,269 6,269 9,269 3,000

Seclusion & Restraint......................................................... 1,147 1,147 1,147 -

Assisted Outpatient Treatment for Individuals with SMI 15,000 19,000 25,000 6,000

Assertive Community Treatment for Individuals with SMI 5,000 7,000 25,000 18,000

Comprehensive Opioid Recovery Centers......................... -- 2,000 2,000 -

Tribal Behavioral Health Grants........................................ 20,000 20,000 20,000 -

Infant and Early Childhood Mental Health........................ 5,000 7,000 7,000 -

Subtotal, Capacity 429,177 504,616 486,739 -17,877

Science and Service: -

 Primary and Behavioral Health Care Integration TTA....... 1,991 1,991 - -1,991

Practice Improvement and Training................................... 7,828 7,828 7,828 -

Consumer and Consumer Support TA Centers................. 1,918 1,918 1,918 -

Disaster Response.............................................................. 1,953 1,953 1,953 -

Homelessness..................................................................... 2,296 2,296 2,296 -

MH Minority Fellowship Program................................... 8,059 9,059 9,059 -

Subtotal, Science and Service 24,045 25,045 23,054 -1,991

Total, PRNS 453,222 529,661 509,793 -19,868
26

National Child Traumatic Stress Network

(Dollars in thousands)

Programs of Regional and National Significance

FY 

2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 

2020

National Child Traumatic Stress 

Network............................................ $63,887 $68,887 $68,887 $---

Authorizing Legislation ........................................Section 582 of the Public Health Service Act

FY 2021 Authorization ................................................................................................... $63,887,000

Allocation Method .....................................Competitive Grants/Contracts/Cooperative Agreements

Eligible Entities...........................................................................States, Local Governments, Tribes, 

Institutions of Higher Education, and Community Organizations

Program Description and Accomplishments

Child traumatic stress is a pervasive and potentially life changing experience that affects tens of 

thousands of children each year, and is a serious public health challenge. Child traumatic stress 

occurs when children and adolescents are exposed to traumatic events or traumatic situations that 

overwhelm their ability to cope with what they have experienced. Child traumatic stress can 

interfere with a wide range of childhood developmental capabilities, including social and 

educational functioning. There is strong evidence that the negative impact of child trauma 

progresses into adulthood and increases the likelihood of later adverse physical and behavioral 

health outcomes if not recognized and addressed early in life.2

 Studies show estimates as high as 

80 percent of children and adolescents are exposed to traumatic events, with many exposed to 

multiple traumatic events.3 While the effects of trauma and exposure to violence are found in all 

child and adolescent populations and service sectors, it is particularly prominent among youth with 

mental illness and/or drug/alcohol addiction involved in the child welfare, and juvenile justice 

systems. Studies show that youth in foster care can have rates of Post-Traumatic Stress Disorder 

that are nearly double those of combat veterans. 4

Established in 2000, the National Child Traumatic Stress Initiative (NCTSI) aims to improve 

behavioral health services and interventions for children and adolescents exposed to traumatic 

events. SAMHSA has provided funding for a national network of grantees known as the National 

Child Traumatic Stress Network (NCTSN) to develop and promote effective community practices 

for children and adolescents exposed to a wide array of traumatic events. The NCTSN has grown 

 2 Kerker, B.D., Zhang, J., Nadeem, E., Stein, R.E., Hurlburt, M.S., Heneghan, A., Landsverk, J., McCue Horwitz S 

(2015). Adverse childhood experiences and mental health, chronic medical conditions, and development in young 

children. Academy of Pediatrics, 13(15), 00173-00174. 3 Fairbank, J.A. (2008). The epidemiology of trauma, and trauma related disorders in children and youth. PTSD 

Research Quarterly, (10), 1050-1835. 4 Pecora, P.J. Kessiler, R.C., Williams, J. O’Brien, K., Downs, A.C., English E., Holmes, K. (2005). Improving 

family foster care: Findings from the northwest foster care alumni study. Casey Family Programs, Retrieved from 

https;/www.casey.org/resources/publications/ImprovingFamilyCare.htm.
27

from a collaborative network of 17 centers to 100 funded and over 150 affiliate centers located 

nationwide in universities, hospitals, and a range of diverse community-based organizations with 

thousands of national and local partners. The NCTSN’s mission is to raise the standard of care and 

improve access to evidence-based services for children experiencing trauma, their families, and 

communities. A component of this work has been the development of resources and delivery of 

training and consultation to support the development of trauma-informed child-serving systems. 

Network members work together within and across diverse settings, including a wide variety of 

governmental and non-governmental organizations.

Data collected in FY 2019 demonstrate that the current NCTSN grantees provided screening to over 

60,000 individuals and evidence-based treatment to over 59,000 children, adolescents, and family 

members. Seventy percent reported positive functioning at six months. In addition, thousands more 

youth and families have benefited indirectly from the training and consultation provided by NCTSN 

grantees to organizations not receiving direct NCTSN funding enabling these organizations to 

deliver evidence-based trauma interventions. 

The NCTSN continues to be a principal source of child-trauma information and training for the 

nation. In FY 2019, NCTSN grantee sites provided trauma-informed training to over 254,000 

individuals. Since its inception, the NCTSN has provided training on best practices and other 

aspects of child trauma to over 1.5 million participants throughout the country. The NCTSI 

Learning Center now has over 250,000 users accessing evidence-based child trauma resources. 

In FY 2018, SAMHSA awarded 14 new grants and supported 86 grant continuations. SAMHSA 

will continue to ensure that grantees disseminate information regarding evidence-based 

interventions for the prevention and treatment of childhood trauma so more children can benefit 

from proven practices. 

In FY 2019, SAMHSA supported 100 grant continuations and provided supplemental awards for 

mental health services for unaccompanied alien children, with a special focus on children who were 

separated from a parent or family unit and subsequently classified as unaccompanied alien children; 

mental health services for children in Puerto Rico; and expanded access to tribal populations. In 

FY 2020, SAMHSA will fund a 100 grant continuations, award a new cohort of 14 grants, provide 

supplemental funding for mental health services for unaccompanied alien children, and provide 

supplemental funding to the NCTSI Coordinating Center for increased coordination of training in 

evidence-based and trauma informed treatments and practices and dissemination of evidence-based 

and trauma-informed interventions and treatments.
28

Funding History

 Fiscal Year Amount

FY 2017 $48,887,000

FY 2018 $53,887,000

FY 2019 $63,887,000

FY 2020 $68,887,000

FY 2021 $68,887,000

Budget Request

The FY 2021 President’s Budget is $68.9 million, level with the FY 2020 Enacted level. This 

funding will support 32 continuation grants and 91 new grants for the improvement of mental 

disorder treatment, services, and interventions for children and adolescents exposed to traumatic 

events and provide trauma-informed services for children and adolescents as well as training for 

the child-serving workforce. 
29

Outputs and Outcomes Table

Program: National Child Traumatic Stress Network

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

3.2.02a Percentage of children 

receiving trauma informed services 

who report positive functioning at 6 

month follow-up (Outcome)

FY 2019: 76.7 %

Target: 74.8 %

(Target Exceeded)

76.7 % 76.7 % Maintain

3.2.23 Unduplicated count of the 

number of children and adolescents 

receiving trauma-informed services 

(Outcome)

FY 2019: 68,177

Target: 47,108

(Target Exceeded)

68,177 68,177 Maintain

3.2.24 Number of child-serving 

professionals trained in providing 

trauma-informed services (Outcome)

FY 2019: 354,800

Target: 276,791

(Target Exceeded)

354,800 354,800 Maintain
30

Project AWARE 

(Dollars in thousands)

Authorizing Legislation ......................... Sections 520A, and 520J of the Public Health Service Act

 FY 2021 Authorization ............................... Project AWARE: $394,550,000; MHAT: $14,693,000

Allocation Method ..............................................................................Competitive Grants/Contracts

Eligible Entities........................................................................ State and Local Education Agencies,

Local Governmental Entities, Community Organizations and Provider Organizations,

Community Colleges, Networks, National Non-Profit Organizations, 

States and Tribes

Program Description and Accomplishments

In any given year the percentage of young people with mental, emotional, behavioral (MEB) 

disorders is estimated to be between 14 and 20 percent. MEB disorders among young people 

interfere with their ability to accomplish normal developmental tasks such as healthy interpersonal 

relationships, succeeding in school, and transitioning to the workforce (IOM 2007). Project 

AWARE is designed to identify children and youth in need of mental health services, increase 

access to mental health treatment, and promote mental health literacy among teachers and school 

personnel.

Project AWARE is made up of three components: Project AWARE State Education Agency (SEA) 

grants, Mental Health Awareness Training (MHAT) Grants, and Resilience in Communities After 

Stress and Trauma (ReCAST) grants. Project AWARE SEA grants are awarded to State Education 

Agencies/Authorities to promote comprehensive, coordinated, and integrated state efforts to make 

schools safer and increase access to mental health services. The program also includes a focus on 

the specific needs affecting rural communities. These communities struggle with access to mental 

health services in schools and access to qualified health professionals to provide such services. 

In FY 2019, Project AWARE grantees trained more than 57,000 teachers, parents, first responders, 

school resource officers, and other adults who interact with youth to recognize and respond to the 

signs of mental health and substance use issues. In FY 2019, Project AWARE grantees in their first 

year of grant activities trained 21,494 individuals in the mental health and related professions. Over 

the course of this program over 250,000 at-risk youth have been identified and referred for mental 

health services and supports.

The MHAT grants train school personnel, emergency first responders, law enforcement, veterans, 

armed services members and their families to recognize the signs and symptoms of mental 

disorders, particularly serious mental illness (SMI) and/or serious emotional disturbances (SED). 

Programs of Regional and National Significance

FY 2019

 Final

FY 2020 

Enacted

 FY 2021

President's 

Budget

FY 2021 

+/-

 FY 2020

Project AWARE and MHAT................................................................. $91,964 $124,964 $124,964 $---

Project AWARE.................................................................................... $71,001 $102,001 $103,001 $1,000

Project AWARE State Grants (non-add)...................................... 61,001 92,001 83,001 -9,000

Project AWARE - Civil Unrest (non-add).................................... 10,000 10,000 10,000 ---

Project AWARE: Rural (non-add)................................................ - - 10,000 10,000

Mental Health Awareness Training................................................... 20,963 22,963 21,963 -1,000
31

In FY 2019, MHAT grantees trained 29,763 individuals in mental health or related professions in 

mental health literacy programs. Grantees provided mental health literacy training to 43,466 

community members. Due to increased awareness of mental health issues, over 42,000 individuals 

have been referred to mental health services and supports as a result of the MHAT grant.

ReCAST grants assist high-risk youth and families and promote resilience in communities that have 

recently faced civil unrest through implementation of evidence-based violence prevention, and 

community youth engagement programs, as well as linkages to trauma-informed behavioral health 

services. ReCAST grantees developed culturally responsive approaches to build capacity with 

community based partners. 

In FY 2019, ReCAST grantees trained, 3,113, members of the mental health workforce in trauma 

informed approaches. Nearly 22,000 community stakeholders were trained in trauma-informed 

approaches, including violence prevention and mental health literacy. ReCAST grantees provided 

18,496 at-risk youth and their family members with high-quality trauma-informed mental health 

services. Nearly 3,000 new partnerships were established among local municipal organizations and 

community agencies to support high-risk youth and their families.

In FY 2018, SAMHSA awarded 24 new AWARE-SEA grants, 138 MHAT grants, 2 ReCAST 

grants, and supported the continuation of 16 grants (8 AWARE-SEA and 8 ReCAST grants). The 

Program also supported technical assistance to develop school-based mental health models. 

In FY 2019, SAMHSA awarded 6 new AWARE-SEA and 18 new MHAT grants and supported 

the continuation of 173 grants, (24 AWARE, 138 MHAT, and 11 ReCAST grants).

In FY 2020, SAMHSA anticipates funding 197continuation grants, (30 AWARE, 156 MHAT, 

and 11 ReCAST grants) and a new cohort of 32 grants (17 AWARE and 15 MHAT grants).

 Funding History

Fiscal Year Amount

FY 2017 $68,964,000

FY 2018 $90,964,000

FY 2019 $91,964,000

FY 2020 $124,964,000

FY 2021 $124,964,000
32

Budget Request

The FY 2021 President’s Budget is $124.9 million, level with the FY 2020 Enacted level. Funding 

for this program will support Project AWARE, ReCAST, MHAT grants, and technical assistance 

on the provision of school-based mental health services. The Federal Commission School Safety’s 

(FCSS) listening sessions, site visits, and Commission meetings, learned that mental health supports 

and services are lacking in schools across the country. SAMHSA is proposing to use this funding 

to continue much needed services, supports, and training related to school-based mental health 

service provision. In addition, the funding will be used to continue an expansion of the AWARE 

model to rural communities. These funds will support increased access to services in rural schools 

through telehealth models, use of behavioral health aides, and linkages to services. Funds would 

also be used to develop trainings in rural communities to for school personnel to recognize the signs 

and symptoms of mental illness in students. 
33

Outputs and Outcomes Table

Program: Project AWARE

Measure

Year and Most Recent Result 

Target for Recent Result

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

3.2.39 Number of individuals 

who have received training in 

prevention or mental health 

promotion (Outcome)

FY 2019: 177,086.05

Target: 59,186.0

(Target Exceeded)

177,086.0 194,795.0 +17,705

3.2.51 Number of individuals 

referred to mental health or 

related interventions (Output)

FY 2019: 107,744.0

Target: 70,000.0

(Target Exceeded)

107,744.0 118,518.0 +10,774

 5

Measure was unfunded for FY2019
34

Healthy Transitions

(Dollars in thousands)

Programs of Regional and National Significance

FY 

2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 

2020

Healthy Transitions...................................................................... $25,951 $28,951 $30,951 $2,000 

Authorizing Legislation.................................Section 520A of the Public Health Service Act

 FY 2021 Authorization ................................................................................................. $394,550,000

 Allocation Method ..............................................................................Competitive Grants/Contracts

 Eligible Entities....................................................................................................... States and Tribes

Program Description and Accomplishments

Youth and young adults with Serious Emotional Disturbance (SED) or Serious Mental Illness 

(SMI), along with those with co-occurring mental illness and drug/alcohol addiction, face a more 

difficult transition to adulthood than do their peers. Nearly 20 percent of young adults aged 18 to 

25 living in U.S. households had a diagnosable mental health condition in the past year. Of these, 

more than 1.3 million had a disorder so serious, such as schizophrenia, bipolar disorder, and major 

depression, that it compromised their ability to function. Compared to their peers, these young 

people were significantly more likely to experience homelessness,6 be arrested,7 drop out of 

school,8 and be unemployed.9 It is important to identify these young people, develop appropriate 

outreach and engagement processes, and facilitate access to effective clinical and supportive 

interventions. Outreach and engagement are essential to these youth and young adults, and their 

families, as many are disconnected from social and other community supports.

 

The Healthy Transitions program provides grants to states and tribes to improve access to mental 

disorder treatment and related support services for young people aged 16 to 25 who either have, or 

are at risk of developing, a serious mental health condition. Grantees use these funds to provide 

services and supports to address serious mental health conditions, co-occurring disorders, and risks 

for developing serious mental health conditions among youth 16 – 25 years old. This will be 

accomplished by increasing awareness, screening and detection, outreach and engagement, referrals 

to treatment, coordination of care and evidence-informed treatment for this age group. Healthy 

Transitions will increase awareness about early indications of signs and symptoms for serious 

mental health concerns; identify action strategies to use when a serious mental health concern is 

detected; provide training to provider and community groups to improve services and supports 

 6 Embry, L. E., Vander Stoep, A., Evens, C., Ryan, K. D., & Pollock, A. (2009). Risk factors for homelessness in 

adolescents released from psychiatric residential treatment. Journal of the American Academy of Child and Adolescent 

Psychiatry, 39(10), 1293-1299. 7 Davis, M., Banks, S. M., Fisher, W. H., Gershenson, B.,& Grudzinskas, A. J. (2007). Arrests of adolescents clients 

of a public mental health system during adolescence and young adulthood. Psychiatric Services, 58(11), 1454-1460. 8 Planty, M., Hussar, W., Snyder, T., Provasnik, S., Kena, G., Dinkes, R., Kemp, J. (2008). The condition of education 

2008 (NCES 2008-031). 9 Newman, L., Wagner, M., Cameto, R., & Knokey, A. M. (2009). The post-high school outcomes of youth with 

disability up to 4 years after high school: A report from the national longitudinal transition study-2 (NLTSC) (NCSER 

2009-3017). Menlo Park, CA: SRI International.
35

specific to this age group; enhance peer and family supports, and develop effective services and 

interventions for youth, young adults and their families as these young people transition to adult 

roles and responsibilities. Since 2014, a total of 9,097 youth have been served to date.

FY 2019 data showed a 7.3 percent decrease in psychological distress characteristics, a 23.8 percent 

improvement in functional outcomes, an increase in being in excellent or very good health, and an 

increase in rates of employment (full or part-time). In addition, from baseline to 6-month followup there was a 14.6 percent decrease in the number of nights young adults reported being homeless. 

In FY 2018, SAMHSA awarded 10 new Healthy Transitions grants and 16 continuation grants. In 

FY 2019, SAMHSA awarded 15 new Healthy Transitions grants and 10 continuation grants. In FY 

2020, SAMHSA will fund 25 continuation grants and award two new grants.

. 

Funding History

Fiscal Year Amount

FY 2017 $19,951,000

FY 2018 $25,951,000

FY 2019 $25,951,000

FY 2020 $28,951,000

FY 2021 $30,951,000

Budget Request

The FY 2021 President’s Budget is $30.9 million, an increase of $2.0 million from the FY 2020 

Enacted level. This funding will improve access to mental disorder treatment and related support 

services for young people age 16 to 25 who either have, or are at risk of developing, a serious 

mental health condition. SAMHSA’s budget request will support 27 continuation grants and award 

a new cohort of two grants focused on students with or at risk of serious mental illness in rural 

areas, trade schools, colleges, including community colleges and universities. 
36

Outputs and Outcomes Table

Program: Healthy Transitions

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

3.2.34 Percentage of clients 

receiving services who report 

positive functioning at 6 month 

follow-up. (Outcome)

FY 2019: 58.7 %

Target: 66.1 %

(Target Not Met)

58.7 % 66.1 % +7.4%

3.2.35 Percentage of clients 

receiving services who had a 

permanent place to live in the 

community at 6 month follow-up. 

(Outcome)

FY 2019: 35 %

Target: 52 %

(Target Not Met)

35 % 52 % +17%

3.2.36 Percentage of clients 

receiving services who are currently 

employed at 6 month follow-up. 

(Outcome)

FY 2019: 61 %

Target: 66.8 %

(Target Not Met)

61 % 66.8 % +7.8%
37

Children and Family Programs

(Dollars in thousands)

Programs of Regional and National Significance

FY 

2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 

2020

Children and Family Programs.................................................... $7,229 $7,229 $7,229 $---

Authorizing Legislation.................................Section 520A of the Public Health Service Act

 FY 2021 Authorization.................................................................................................. $394,550,000

 Allocation Method......................................Competitive Grants/Contracts/ Interagency Agreements

 Eligible Entities.........................................................................................................................Tribes

Program Description and Accomplishments

Without early identification, intervention, treatment, and support, children with Serious Emotional 

Disturbances (SED) are likely to face challenges at home, in school, and in their psychosocial 

development. It is a public health priority that these children and their families have access to 

effective, evidence-based services, and support. 

SAMHSA’s Children and Family Programs provide funding for the Circles of Care grant program. 

Initially funded in 1998, the Circles of Care Program is a three-year infrastructure/planning grant 

that seeks to promote mental disorder treatment equity by providing American Indian/Alaska 

Native (AI/AN) communities with tools and resources to design and sustain their own culturally 

competent system of care approach for children. The Circles of Care program reflects the unique 

history and needs of individual AI/AN communities and promotes the idea of building on cultural 

strengths. The program increases capacity and community readiness to address the mental health 

issues of children and their families through the provision of evidence-based treatment services and 

supports. This grant program is of critical importance as there are significant mental health needs 

in AI/AN communities. For example, suicide is the second leading cause of death for Indian youth 

ages 15 to 24. 

Through Circles of Care, SAMHSA has improved the availability, accessibility, and acceptability 

of behavioral health services for native youth. In FY 2019, 1,100 individuals received training in 

mental health practices and activities that aligned with the goals of the program. In addition, 288 

organizations collaborated and coordinated resources with other organizations.

In FY 2018, SAMHSA awarded 1 new and 13 Circles of Care continuation grants, and technical 

assistance activities. In FY 2019, SAMHSA supported 14 Circles of Care continuation grants. In 

FY 2020, SAMHSA will fund a new cohort of 13 Circles of Care grants and one continuation grant. 
38

 Funding History

Fiscal Year Amount

FY 2017 $7,229,000

FY 2018 $7,229,000

FY 2019 $7,229,000

FY 2020 $7,229,000

FY 2021 $7,229,000

Budget Request

The FY 2021 President’s Budget is $7.2 million, level with the FY 2020 Enacted level. SAMHSA 

requests funding to enhance and improve the quality of existing services and promote the use of 

culturally competent services and support for children and youth with, or at risk for, serious mental 

health conditions and their families. This funding will be used to support 13 Circles of Care 

continuation grants and provide supplemental funding for the school based mental health services.

The output and outcome measures for Children and Family Programs are part of the Mental Health 

- Other Capacity Activities Outputs and Outcomes table shown on page 87. 
39

Consumer and Family Network Grants

(Dollars in thousands)

Programs of Regional and National Significance

FY 

2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 

2020

Consumer and Family Network Grants....................................... $4,954 $4,954 $4,954 $---

Authorizing Legislation.................................Section 520A of the Public Health Service Act

 FY 2021 Authorization ................................................................................................. $394,550,000

 Allocation Method ..............................................................................Competitive Grants/Contracts

 Eligible Entities........................................................................................ Community Organizations

Program Description and Accomplishments

Across the healthcare arena, there is growing recognition and evidence that patient-centered care 

positively influences an individual’s health outcomes, improves quality and efficacy of care 

received, and provides feedback to drive service and systems improvements. As with other health 

disciplines, people with SMI and their family members should have meaningful involvement in all 

aspects of their health care and treatment, including behavioral health care. 

The Consumer and Family Network Programs provide consumers, families, and youth with 

opportunities to participate meaningfully in the development of policies, programs, and quality 

assurance activities related to mental health systems across the United States. The Consumer and 

Family Network Programs support two primary grant activities: the Statewide Consumer Network 

(SCN) Program and the Statewide Family Network (SFN) Program.

The SCN grant program focuses on the needs of adults (18 years and older) with SMI by 

strengthening the capabilities of statewide consumer-run organizations. These entities serve an 

important role in engaging consumers of mental health services, caregivers, policy makers, and 

providers in improving and transforming the mental health and related systems in their states. This 

network is a sustainable mechanism for integrating the consumer voice in state mental health and 

allied systems to: 1) expand service system capacity; 2) support policy and program development; 

and 3) enhance peer support. This program promotes skill development with an emphasis on 

leadership and business management as well as coalition/partnership-building and economic 

empowerment as part of the recovery process for consumers. 

The SFN grant program provides education and training to increase family organizations’ capacity 

for policy and service development. This is accomplished by: 1) strengthening organizational 

relationships and business management skills; 2) fostering leadership skills among families of 

children and adolescents with SED; and 3) identifying and addressing the technical assistance needs 

of children and adolescents with SED and their families. The SFN program focuses on families, 

parents, and the primary caregivers of children, youth, and young adults.

In FY 2019, SCN grantees trained 5,896 individuals of the mental health and related workforce and 

engaged over 100,000 individuals in mental health awareness activities, and trained over 1,00 

members of the public.
40

In FY 2019, SFN grantees trained 12,260 individuals in the mental health and related workforce 

and 12,191 consumers and family members were involved in ongoing mental health-related 

planning and advocacy activities.

In FY 2018, SAMHSA supported 10 SCN continuations and 13 new grants, 22 SFN continuations 

and 10 new grants. In FY 2019, SAMHSA supported 14 SCN continuations and 8 new grants, 11 

SFN continuations and 18 new grants. In FY 2020, SAMHSA will fund 21 SCN and 28 SFN 

continuation grants.

 Funding History

Fiscal Year Amount

FY 2017 $4,954,000

FY 2018 $4,954,000

FY 2019 $4,954,000

FY 2020 $4,954,000

FY 2021 $4,954,000

Budget Request

The FY 2021 President’s Budget is $4.9 million, level with the FY 2020 Enacted level. SAMHSA 

requests funding for 10 new SFN, 13 new SCN, and 26 continuation grants that promote consumer, 

family, and youth participation in the development of policies, programs, and quality assurance 

activities related to mental health systems reform across the United States. 

The output and outcome measures for Consumer and Family Network Programs are part of the 

Mental Health - Other Capacity Activities Outputs and Outcomes table shown on page 87.
41

Project LAUNCH

(Dollars in thousands)

Programs of Regional and National Significance

FY 

2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 

2020

Project LAUNCH........................................................................ $23,605 $23,605 $23,605 $---

Authorizing Legislation..........................................Section 520A of the Public Health Act

 FY 2021 Authorization.................................................................................................. $394,550,000

 Allocation Method......................................Competitive Grants/Contracts/Cooperative Agreements

 Eligible Entities....................................................................................................... States and Tribes

Program Description and Accomplishments

Researchers estimate that between 9.5 percent and 14.2 percent of children from birth to age five 

experience an emotional or behavioral disturbance. Studies also show that half of all lifetime cases 

of mental illness begin before age 14.10 Young children experiencing mental, emotional or 

behavioral challenges are at high risk for preschool expulsion. In fact, preschool expulsion rate is 

more than three times the expulsion rate of students in kindergarten through 12th grade. Boys are 

more than four times as likely to be expelled as girls; and African American preschoolers are almost 

twice as likely to be expelled as Caucasian preschoolers.11 School suspensions and expulsions have 

shown to increase the likeliness of later life negative outcomes. Research has shown that prevention 

and early treatment of mental disorders is more beneficial and cost-effective than waiting to address 

these issues later in life. Integrating behavioral health into primary care and child care settings, 

increasing screening for developmental and social/emotional issues, and training people who 

interact with young children to promote optimal development and mental health are all critical 

elements to ensure children start life with the tools and skills needed to succeed. 

Established in 2008, Project LAUNCH (Linking Actions for Unmet Needs in Children’s Health) 

is a national initiative that has funded a total of 90 grantees in nine cohorts: this includes 

communities in 38 states; 23 tribal entities; 4 US territories; 3 Alaska/native communities; and the 

District of Columbia. Project LAUNCH Expansion grantees are five alumni states that are engaged 

in replication of successful Project LAUNCH prevention strategies in new communities within each 

state. All grantees are funded for a total of four or five years. The purpose of the Project LAUNCH 

initiative is to promote the wellness of young children from birth to eight years of age by addressing 

the physical, social, emotional, cognitive, and behavioral aspects of their development. Project 

LAUNCH pays particular attention to the social and emotional development of young children and 

works to ensure that the systems that serve them (including childcare and education, home visiting, 

and primary care) are equipped to promote and monitor healthy social and emotional development. 

The program also ensures that the systems intervene to prevent, recognize early signs of, and 

address mental, emotional, and behavioral disorders in early childhood and into the early 

elementary grades.

 10 Brauner, Cheryl, and Cheryll Stephens. "Estimating the Prevalence of Early Childhood Serious Emotional/Behavioral 

Disorders: Challenges and Recommendations." Public Health Reports 121.3 (2006): 303-10. 11 Gilliam, W. (2005). Pre-kindergarteners left behind: Expulsion rates in state prekindergarten systems. Foundation 

for Child Development.
42

Program Evaluation 

As of 2019, cumulative performance data for the program (2008-2019) indicate that more than 

241,000 children and parents have been screened or assessed for behavioral health concerns across 

a range of diverse settings (e.g., primary care, child care, and home visiting); Child screenings are 

a critical step in the early recognition of social emotional concerns and create a pathway to 

prevention and treatment services. Adult screenings include screening for perinatal depression, 

substance use, and a range of social needs; More than 100,000 community providers have been 

trained on milestones of social/emotional development, early detection of behavioral health issues, 

and best practices for mental health treatment. Over 203,000 children and parents/caregivers have 

received evidence-based mental health-related services through the grant program, and 

approximately 10,500 new partnerships have been developed between organizations in order to 

improve care coordination and access to quality mental health services for young children and 

families. 

A multi-site evaluation of Project LAUNCH was completed in 2018 

(https://www.acf.hhs.gov/opre/research/project/cross-site-evaluation-of-project-launch-linkingactions-for-unmet-needs-in). Phase one of the evaluation used a meta-analytical approach to assess 

the implementation of the program. The findings indicated that grantees successfully improved 

community and state-level child and family-serving systems. In addition, grantees demonstrated 

improved social and academic functioning among young children, and 78 percent reported 

decreases in problem behaviors. Phase two of the multi-site evaluation involved a quasiexperimental design exploring whether children in 10 communities served by Project LAUNCH 

differed in social and emotional wellbeing from children in 10 socio-demographically matched 

communities. Results indicated that children living in Project LAUNCH communities received 

more developmental screening and supports than children living in matched comparison 

communities. Additionally, children served in LAUNCH communities had less need for early 

intervention services related to attachment, initiative and other indicators of resilience, particularly 

for young children ages birth to three. Parents in Project LAUNCH communities reported more 

involvement with their children and less parenting frustrations.
43

In FY 2018, SAMHSA awarded 18 continuation grants, including 13 grants to states, tribes and 

territories implementing Project LAUNCH in one target community, and 5 grants that had 

previously successfully implemented Project LAUNCH in one community, and are now engaged 

in a project to replicate that work more widely. In addition, SAMHSA awarded 14 new grants to 

American Indian and Alaskan Native communities and U.S. Territories. 

In FY 2019, SAMHSA supported 14 Project LAUNCH continuation grants and 16 new Project 

LAUNCH grants. In addition, SAMHSA awarded the National Center of Excellence for Infant and 

Early Childhood Mental Health Consultation (CoE-IECMHC) to advance the implementation of 

high quality IECMHC across the nation through the development of tools, resources, training, and 

mentorship to the infant and early childhood mental health field. 

In FY 2020, SAMHSA will fund 30 Project LAUNCH grant continuations and the CoE-IECMHC 

grant.

 Funding History

Fiscal Year Amount

FY 2017 $23,605,000

FY 2018 $23,605,000

FY 2019 $23,605,000

FY 2020 $23,605,000

FY 2021 $23,605,000

Budget Request

The FY 2021 President’s Budget is $23.6 million, level with the FY 2020 Enacted level. This 

funding will support 30 continuation grants and the CoE-IECMHC grant that will improve health 

outcomes for young children and support children at high risk for mental illness and their families 

in order to prevent future disability. This funding request will provide continued screening, 

prevention, early intervention for behavioral health issues and referrals to high quality treatment 

for children and families in 30 communities across the U.S. through the Center of Excellence. 
44

Outputs and Outcomes Table

Program: Mental Health-Project LAUNCH 

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

2.3.94 Number of persons served 

(Output)

FY 2019: 23,809

Target: 14,421

(Target Exceeded)

23,809 23,809 Maintain

2.3.95 Number of persons trained in 

mental illness prevention or mental 

health promotion (Outcome)

FY 2019: 9,458

Target: 8,765

(Target Exceeded)

9,458 9,458 Maintain

2.4.00 Number of 0-8 year old children 

screened for mental health or related 

interventions (Outcome)

FY 2019: 23,809

Target:18,554

(Target Exceeded)

27,824 27,824 Maintain

2.4.01 Number of 0-8 year old children 

referred to mental health or related 

interventions (Outcome)

FY 2019: 7,321

Target: 3,652

(Target Exceeded)

7,340 7,340 Maintain
45

Mental Health System Transformation and Health Reform

(Dollars in thousands)

Programs of Regional and National Significance

FY 

2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 

2020

Mental Health System Transformation and Health Reform..... $3,779 $3,779 $3,779 $---

Authorizing Legislation.................................Section 520A of the Public Health Service Act

 FY 2021 Authorization................................................................................................. $394,550,000

 Allocation Method...............................................................................Competitive Grants/Contracts

 Eligible Entities....................................................................................................... States and Tribes

Program Description and Accomplishments

There is a significant gap between the number of people with SMI, such as schizophrenia, bipolar 

disorder, and major depression, who want to work (66 percent) and the number of people who are 

actually employed (less than 20 percent). The benefits of steady competitive employment are 

substantial and include increased income, improved adherence with treatment for mental illness, 

enhanced self-esteem, reduced use of substances, and improved quality of life.12 The Transforming 

Lives through Supported Employment Grant program is the remaining component of the Mental 

Health System Transformation program. This program was implemented to help states foster the 

adoption and implementation of permanent transformative changes in how public mental health 

services are organized, managed, and delivered throughout the United States. 

The program began in FY 2014 as a focused effort to enhance state and community capacity to 

provide evidence-based supported employment programs for adults and youth with SMI/SED. 

These grants help people with SMI achieve their goals for competitive employment, building paths 

to self-sufficiency and recovery. They also support treatment and service providers and employers 

to prioritize employment as a standard of care by developing and maintaining sustained competitive 

employment opportunities for people with SMI, primarily using the evidence-based Individual 

Placement and Support (IPS) model of supported employment. The grant program helps states to 

identify and implement the structural and financing changes that are essential to make evidencebased supported employment programs sustainable statewide. 

FY 2019 program data show that 4,371 members in the mental health and related workforce were 

trained and 518 programs or organizations implemented mental health practices consistent with 

program goals. In addition, over 50 percent of individuals served by the program were employed 

or in school at six-month follow-up; while, 61 percent reported positive functioning and 68 percent 

had a permanent place to live. Across the five years of the program, the number of individuals 

employed increased by over 110 percent.

In FY 2018 SAMHSA awarded seven continuation grants and related technical assistance activities. 

In FY 2019, SAMHSA awarded seven new Transforming Lives through Supported Employment 

grants. In FY 2020, SAMHSA will fund seven grant continuations and related technical assistance 

activities.

 

IPS Supported Employment: The Evidence-based Practice for Employment. (n.d.). Retrieved August 4, 2015
46

 Funding History

Fiscal Year Amount

FY 2017 $3,779,000

FY 2018 $3,779,000

FY 2019 $3,779,000

FY 2020 $3,779,000

FY 2021 $3,779,000

Budget Request

The FY 2021 President’s Budget is $3.7 million, level with the FY 2020 Enacted level. SAMHSA 

requests funding to support the continuation of seven Transforming Lives through Supported 

Employment grants that will enhance state and community capacity to provide evidence-based 

supported employment programs and mutually compatible and supportive evidence-based practices 

for adults and youth with SMI/SED and co-occurring mental and substance use disorders.
47

Outputs and Outcomes Table

Program: Mental Health System Transformation Grants and Health Reform

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

1.2.11 Number of persons in the mental 

health and related workforce trained in 

specific mental-health related 

practices/activities as a result of the grant 

(Outcome)

FY 2018: 2,010

Target: 5,262

(Target Not Met)

2,010 2,010 Maintain

1.2.21 Percentage of clients receiving 

services who report positive functioning 

at 6 month follow-up. (Outcome)

FY 2018: 67.1 %

Target: 74.0 %

(Target Not Met)

67.1 % 67.1 % Maintain

1.2.22 Percentage of clients receiving 

services who had a permanent place to 

live in the community at 6 month followup. (Outcome)

FY 2018: 66.4 %

Target: 66 %

(Target Exceeded)

66 % 66 % Maintain

1.2.23 Percentage of clients receiving 

services who are currently employed at 6 

month follow-up. (Outcome)

FY 2018: 52.8 %

Target: 55 %

(Target Not Met)

52.8 % 52.8 % Maintain
48

Primary and Behavioral Health Care Integration

(Dollars in thousands)

Programs of Regional and National Significance

FY 2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 2020

Total Primary and Behavioral Health Care Integration $45,429 $51,868 --- -51,868 

Primary and Behavioral Health Care Integration.....................

 

43,438 

 

49,877 --- -49,877 

Primary and Behavioral Health Care Integration TTA............

 

1,991 

 

1,991 --- -1,991 

Authorizing Legislation..................................Section 520K of the Public Health Service Act

FY 2021 Authorization ..................................................................................................$51,878,000

Allocation Method ......................................................Competitive Grants/Cooperative Agreements

Eligible Entities.....................................................Qualified Community Mental Health Programs,

States or State Agency

Program Description and Accomplishments

Adults with SMI, such as schizophrenia, bipolar disorder, and major depression, experience high 

rates of morbidity and mortality. These rates are due, in large part, to elevated incidence and 

prevalence of cardiovascular disease, obesity, diabetes, hypertension, and dyslipidemia in people 

with SMI.13 Physical health problems among people with SMI affect an individual’s quality of life 

and contribute to premature death. Empirical findings indicate the clear link between early 

mortality among people with SMI and the lack of access to primary care services.14

The Primary and Behavioral Health Care Integration (PBHCI) Portfolio began in FY 2009 to 

address specifically this intersection between primary care and treatment for mental illness and cooccurring drug/alcohol addiction. The program supports grants to community mental health centers 

and states. This program supports the coordination and integration of primary care services and 

publicly funded community behavioral health services for individuals with SMI or co-occurring 

mental illness and drug/alcohol addiction served by the public mental health system. The PBHCI 

program seeks to improve health outcomes for people with SMI and co-occurring mental illness 

and drug/alcohol addiction by encouraging grantees to engage in necessary collaboration, expand 

infrastructure, and increase the availability of primary healthcare and wellness services for 

individuals with SMI or co-occurring mental illness and drug/alcohol addiction. 

In FY 2018, SAMHSA supported 59 PBHCI continuation grants and awarded three new Promoting 

Integration of Primary and Behavioral Health Care (PIPBHC) grants at $2.0 million per year to 

states, consistent with the 21st Century Cures Act. In addition, the population of focus was 

expanded to children with SED, individuals with drug/alcohol addiction and adults with any mental 

illness. The PIPBHC grant also focuses on bi-directional integration, providing support to onsite 

primary care within a behavioral health setting and onsite behavioral health care within a primary 

care setting.

 13 Forman-Hoffman, Muhuri, Novak, Pemberton, Ault, and Mannix (August 2014) CBHSQ Data Review: 

Psychological Distress and Mortality among Adults in the U.S. Household Population. 14 E. Chesney et al., Risks of all-cause and suicide mortality in mental disorders: a meta-review, World Psychiatry; 

2014: 13:1153-160.
49

In FY 2019, SAMHSA continued support for 15 PBHCI, 13 PIPBHC, and awarded 6 new PIPBHC 

grants. In FY 2020, SAMHSA will fund one PBHCI, 19 PIPBHC continuation grants, and four 

new PIPBHC grants. 

Program Evaluation 

SAMHSA, in collaboration with Mathematica, conducted a cross-site grantee evaluation of PBHCI 

cohorts 1 - 8. Health outcome data indicated substantial improvements in physical health among 

clients. Diabetes and hypertension were comparable to national benchmarks. Clients also showed 

improvement in functioning and psychological distress. At 18 months of program participation, 

approximately 75 percent of clients had stable housing, 80 percent reported feeling socially 

connected and approximately 55 percent reported feeling healthy overall. Emergency room visits 

for psychiatric or emotional problems and feelings of severe psychological distress were reduced. 

There was some improvement in substance misuse however, rates of tobacco use remained high. 

The evaluation found that nearly 90 percent of grantees in cohorts 6-8 implemented screenings for 

physical health conditions and at least 80 percent provided preventative services and referrals for 

psychosocial services. Peer support staff played an important role in helping to integrate supportive 

care functions within agency settings. Wellness, physical and/or primary care, and mental 

health/substance use disorder services were provided by peer staff to clients. Wellness services 

included tobacco cessation, nutrition and/or exercise, and chronic disease self-management 

programming.

Funding History

Fiscal Year Amount

FY 2017 $51,868,000

FY 2018 $51,868,000

FY 2019 $45,429,000

FY 2020 $51,868,000

FY 2021 ---

Budget Request

The FY 2021 President’s Budget is $0.0 million, a decrease of $51.8 million from the FY 2020 

Enacted level. SAMHSA has eliminated this program due to other funding sources available for 

integrated care. SAMHSA will continue to disseminate the lessons learned from this program. 
50

Outputs and Outcomes Table

Program: Primary & Behavioral Health Care Integration (PBHCI)

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

3.2.41 Increase the percentage of clients 

receiving services who report positive 

functioning at 6 month follow-up. 

(Outcome)

FY 2018: 57.8 %

Target: 54.6 %

(Target Exceeded)

Discontinued Discontinued N/A

3.2.42 Increase the percentage of clients 

receiving services who are currently 

employed at 6 month follow-up. 

(Outcome)

FY 2018: 27.7 %

Target: 24.1 %

(Target Exceeded)

Discontinued Discontinued N/A

3.2.43 Increase the percentage of clients 

receiving services who had a permanent 

place to live in the community at 6 month 

follow-up. (Outcome)

FY 2018: 70.1 %

Target: 71 %

(Target Not Met)

Discontinued Discontinued N/A
51

Suicide Prevention Programs

(Dollars in thousands)

Program Description and Accomplishments

SAMHSA supports the goals and objectives of the National Strategy for Suicide Prevention (NSSP) 

through the Suicide Prevention Programs highlighted below. Research has shown that 

implementing comprehensive public health approaches that make suicide prevention a priority 

within health and community systems can reduce the rates of death by suicide as well as suicide 

attempts. The NSSP supports this type of comprehensive approach and is an important step toward 

reducing suicide. 

Approximately 47,173 Americans died by suicide in 2017. From 1999 through 2017, the age 

adjusted suicide rate increased 33 percent from 10.5 to 14.0 per 100,000. According to the CDC 

Director Robert R. Redfield, “the latest CDC data show that the U.S. life expectancy has declined 

over the past few years. Tragically, this troubling trend is largely driven by deaths from drug 

overdose and suicide”. In 2008, suicide became the 10th leading cause of death in the United States 

and has remained so through 2017. Suicide is the second leading cause of death between age 10-

34 and the fourth leading cause of death for ages 35-54. The 2018 National Survey on Drug Use 

and Health reported that approximately 1.4 million Americans age 18 and over attempted suicide, 

10.7 million seriously considered suicide, and 3.3 million made a plan. While youth have the 

highest rate of suicide attempts, middle-aged adults have the highest number of deaths by suicide 

nationwide, and middle aged and older adult men have the highest rates of death by suicide. The 

nation’s suicide prevention efforts must address the issues of suicidal thoughts, plans, attempts, and 

deaths among adults and youth to reduce suicide in America. 

Programs of Regional and National Significance

FY 2019

 Final

FY 2020 

Enacted

 FY 2021

President's 

Budget

FY 2021 

+/-

 FY 2020

Suicide Prevention................................................................................... $74,034 $90,034 $93,034 $3,000

Suicide Lifeline (non-add)................................................................ 12,000 19,000 19,000 ---

GLS - Youth Suicide Prevention - States (non-add)..................... 35,427 35,427 35,427 ---

Budget Authority (non-add).......................................................... 23,427 23,427 35,427 12,000

Prevention & Public Health Fund (non-add)............................ 12,000 12,000 - -12,000

GLS - Youth Suicide Prevention - Campus (non-add)................. 6,488 6,488 6,488 ---

GLS - Suicide Prevention Resource Center (non-add)................ 5,988 7,988 7,988 ---

AI/AN Suicide Prevention Initiative (non-add)............................ 2,931 2,931 2,931 ---

National Strategy for Suicide Prevention (non-add).................. 11,200 18,200 21,200 $3,000

Zero Suicide (non-add)................................................................... 9,200 16,200 19,200 ---

 gy f ( Zero Suicide -AI/AN (non-add)............................................... 2,200 2,200 2,200 ---

add) 2,000 2,200 2,200 ---
52

National Strategy for Suicide Prevention

(Dollars in thousands)

Authorizing Legislation ............................................Section 520L of the Public Health Service Act

FY 2021 Authorization ................................................................................................... $30,000,000

Allocation Method ...............................................................................................Competitive Grants

Eligible Entities........................................................ Community –based primary care or behavioral 

health entity, Federally Recognized, American Indian/Alaska Native tribe or tribal organizations, 

State mental health or public health agency

Program Description and Accomplishments

Suicide has been increasing in the United States, particularly in adults and older adults. The CDC 

(2018) has recently reported that suicide has risen nearly 30 percent during 1999-2016 and has 

increased in 49 of the 50 states with 25 states experiencing increases over 30 percent.15 With the 

rising rates of suicide among adults, particularly middle-aged and older adults, focusing on 

preventing suicide among adults is urgently required in order to reduce suicide nationally. The 

baby boomer generation is the group that has had high rates of suicide throughout its lifecycle and 

is entering the stage of life that has historically had the highest rate of suicide. There is a risk that 

without significant targeted intervention toward adults, the number of suicides in the United States 

could continue to increase. 

The 2012 National Strategy for Suicide Prevention (NSSP) seeks to reduce the overall suicide rate 

and number of suicides in the U.S. nationally. The NSSP grant program supports states’ efforts to 

implement the NSSP. While the NSSP addresses all age groups and populations with specific 

needs, the goals and objectives of the NSSP grants focus on preventing suicide and suicide attempts 

among adults over the age of 25 who comprised more than 40,000 of the more than 47,000 suicides 

in the United States in 2017. States use NSSP funding to support efforts such as raising suicide 

awareness, establishing emergency room referral processes, and improving clinical care practice 

standards. 

The Zero Suicide model is a comprehensive, multi-setting approach to suicide prevention in health 

systems. The purpose of this program is to implement suicide prevention and intervention programs 

for individuals who are 25 years of age or older by systematically applying evidence-based 

approaches to screening and risk assessment, developing care protocols, collaborating for safety 

planning, providing evidence-based treatments, maintaining continuity of care during high risk 

 15Center for Disease Control and Prevention, Mortality and Morbidity Weekly Report; “Vital Signs: Trends in State 

Suicide Rates-United States, 1999-2016 and Circu7mstances Contributing to Suicide -27 States, 2015, Stone, D.M et 

all, June 8, 2018. 

Programs of Regional and National Significance

FY 2019

 Final

FY 2020 

Enacted

 FY 2021

President's 

Budget

FY 2021 

+/-

 FY 2020

National Strategy for Suicide Prevention............................................. $11,200 $18,200 $21,200 $3,000

Zero Suicide (non-add)................................................................... 9,200 16,200 19,200 3,000

Zero Suicide -AI/AN (non-add)............................................... 2,200 2,200 2,200 $---

All Other National Strategy for Suicide Prevention (non-add)............. 2,000 2,000 2,000 $---
53

periods, and improving care and outcomes for such individuals who are at risk for suicide being 

seen in health care systems. 

In FY 2019, the Zero Suicide grant program trained 9,455 individuals in mental health related 

practices and activities, 112,176 individuals were screened for mental health or related 

interventions, and 61,384 individuals were referred to mental health services. In FY 2018, 

SAMHSA provided support for 5 NSSP continuation grants, and awarded 15 new Zero Suicide 

grants. In FY 2019, SAMHSA supported the continuation of 5 NSSP grants and 15 Zero Suicide 

continuation grants. In FY 2020, SAMHSA will fund 15 Zero Suicide continuation grants, a new 

cohort of five NSSP grants, and a new cohort of 14 Zero Suicide grants. 

 Funding History

Fiscal Year Amount

FY 2017 $11,000,000

FY 2018 $11,000,000

FY 2019 $11,200,000

FY 2020 $18,200,000

FY 2021 $21,200,000

Budget Request

The FY 2021 President’s Budget is $21.2 million, an increase of $3.0 million from the FY 2020 

Enacted level. This funding will support a new cohort of 4 Zero Suicide grants, 29 Zero Suicide 

continuation grants, and five NSSP continuation grants. This funding level will screen an additional 

550,000 individuals for suicide risk. The grants support states in implementing the NSSP goal to 

prevent suicide. States use NSSP funding to support efforts such as raising suicide awareness, 

establishing emergency room referral processes, and improving clinical care practice standards.
54

Garrett Lee Smith Youth Suicide Prevention – State/Tribal and Campus

(Dollars in thousands)

Authorizing Legislation .......................Sections 520E and 520E-2 of the Public Health Service Act

FY 2021 Authorization ...............................................................................$30,000,000; $7,000,000

Allocation Method .....................................Competitive Grants/Contracts/Cooperative Agreements

Eligible Entities....................................................................................................... States and Tribes

Program Description and Accomplishments

In the fall of 2003, Garrett Lee Smith, son of Sen. Gordon and Sharon Smith, died by suicide in his 

apartment in Utah where he attended college. He was one day shy of 22 years old. Like most 

suicides, Garrett's came unexpectedly. As many families have tragically experienced, depression 

is not rare or peculiar, but can be deadly. It affects one in six Americans at some point. Hardly a 

family goes untouched.16

The Garrett Lee Smith (GLS) Memorial Act authorizes SAMHSA to manage two significant youth 

suicide prevention programs and one resource center. The GLS State/Tribal Youth Suicide 

Prevention and Early Intervention Grant Program has awarded 230 grants to 50 states and the 

District of Columbia, 63 unique tribes/tribal organizations, and two territories. These grants 

develop and implement youth suicide prevention and early intervention strategies involving publicprivate collaboration among youth-serving institutions. The GLS Campus Suicide Prevention 

program has awarded 293 grants to 265 institutions of higher education, including tribal colleges 

and universities, to prevent suicide and suicide attempts. Grantees use their funds to prevent suicide 

in their communities, often through providing trainings and activities aimed at identifying youth at 

risk for suicide.. 

Performance Evaluation Information

SAMHSA’s evaluation of national youth suicide prevention efforts (age 10 to 24) have shown that 

counties implementing SAMHSA funded GLS youth suicide prevention activities have lower rates 

of youth suicide deaths than matched counties not implementing such activities. This impact is 

maintained for two years and the impact appears directly related to years of continued funding. 

Approximately 50 percent of the counties in America have received at least one year of funding 

since the program started in 2005.

Recent evaluation results have shown that counties who implemented GLS supported activities had 

lower suicide rates than matched counties that did not in the two years following suicide prevention 

activities.

Since 2005 over 1.6 million individuals’ participated in over 39,000 training events or educational 

seminars provided by grantees. In FY 2019, 195,000 youth were screened for suicide risk, 30,362 

 16 http://www.jaredstory.com/garrett_smith.html

Programs of Regional and National Significance

FY 2019

 Final

FY 2020 

Enacted

 FY 2021

President's 

Budget

FY 2021 

+/-

 FY 2020

GLS - Youth Suicide Prevention - States.............................................. $35,427 $35,427 $35,427 $12,000

Prevention & Public Health Fund (non-add)............................... 12,000 12,000 --- -12,000

GLS - Youth Suicide Prevention - Campus.......................................... 6,488 6,488 6,488 $---
55

youth were referred to services, and over 261,000 individuals were contacted through program 

outreach efforts. Grantees’ efforts are reducing the likelihood of at-risk youth falling through the 

gaps in the system.

In FY 2019, SAMHSA supported the continuation of 19 GLS State/Tribal grants and 41 GLS 

Campus grants, and awarded 31 new GLS State and Tribal grants and 22 new GLS Campus grants. 

In FY 2020, SAMHSA will fund 38 GLS State and Tribal continuation grants [32 with direct budget 

authority and six with Prevention and Public Health Funds (PPHF], 46 GLS Campus continuation 

grants, award a new cohort of 10 GLS State and Tribal grants with PPHF, and 16 GLS Campus 

grants.

 Funding History

Fiscal Year Amount

FY 2017 $41,915,000 

FY 2018 $41,915,000 

FY 2019 $41,915,000 

FY 2020 $41,915,000 

FY 2021 $41,915,000

Budget Request

The FY 2021 President’s Budget is $41.9 million, level with the FY 2020 Enacted level. SAMHSA 

requests direct budget authority funding for the continuation of 44 GLS State and Tribal grants and 

38 GLS Campus grants and a new cohort of three GLS State and Tribal and 22 GLS Campus grants 

to continue developing and implementing youth suicide prevention and early intervention strategies 

involving public-private collaboration among youth serving institutions. 
56

Garrett Lee Smith Suicide Prevention Resource Center

(Dollars in thousands)

Programs of Regional and National Significance

FY 

2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 

2020

GLS - Suicide Prevention Resource Center................................. $5,988 $7,988 $7,988 $---

Authorizing Legislation..................................Section 520C of the Public Health Service Act

FY 2021 Authorization ..................................................................................................... $5,988,000

Allocation Method ..............................................................................Competitive Grants/Contracts

Eligible Entities...................................................... Domestic Public and Private Nonprofit Entities, 

Tribal and Urban Indian Organizations, Community and Faith-Based Organizations

Program Description and Accomplishments

In addition to the above programs that build suicide prevention capacity, SAMHSA also supports 

the Suicide Prevention Resource Center (SPRC). The purpose of this program is to build national 

capacity for preventing suicide by providing technical assistance, training, and resources to assist 

states, tribes, organizations, and SAMHSA grantees to develop suicide prevention strategies 

(including programs, interventions, and policies that advance the National Strategy for Suicide 

Prevention (NSSP), with the overall goal of reducing suicides and suicidal behaviors in the nation. 

This work includes support of the public-private National Action Alliance for Suicide Prevention, 

and working to advance high-impact objectives of the NSSP. 

Recent data shows that nearly 38,000 individuals where exposed to mental health awareness 

messages and over 31,000 individuals were trained in prevention and mental health promotion.

In FY 2018 and FY 2019, SAMHSA supported the continuation grant. In FY 2020, SAMHSA will 

fund one new grant to promote the implementation of the NSSP and enhance the nation’s mental 

health infrastructure. In addition, funding will support the development and dissemination of 

resources for families and friends of individuals at risk of suicide, as well as the development of 

specialized training for LGBTQ youth. 

 
57

 Funding History

Fiscal Year Amount

FY 2017 $5,988,000 

FY 2018 $5,988,000 

FY 2019 $5,988,000 

FY 2020 $7,988,000 

FY 2021 $7,988,000

Budget Request

The FY 2021 President’s Budget is $7.9 million, level with the FY 2020 Enacted level. This 

funding will support one continuation grant. The Suicide Prevention Resource Center will provide 

states, tribes, government agencies, private organizations, colleges and universities, and suicide 

survivors and mental health consumer groups with access to information and resources that support 

program development, intervention implementation, and adoption of policies that prevent suicide. 
58

Suicide Lifeline

(Dollars in thousands)

Programs of Regional and National Significance

FY 

2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 

2020

Suicide Lifeline............................................................................ $12,000 $19,000 $19,000 $---

Authorizing Legislation ........................................ Section 520E-3 of the Public Health Service Act

FY 2021 Authorization ..................................................................................................... $7,198,000

Allocation Method ..............................................................................Competitive Grants/Contracts

Eligible Entities.................................................................States, Tribes, Community Organizations

Program Description and Accomplishments

To prevent death and injury as the result of suicide attempts, individuals need rapid access to suicide 

prevention and crisis intervention services. Launched in 2005, the National Suicide Prevention 

Lifeline (Lifeline), 1-800-273-TALK, coordinates a network of 171 crisis centers across the United 

States by providing suicide prevention and crisis intervention services for individuals seeking help 

at any time, day or night. 

The Lifeline routes calls from anywhere in the country to a network of certified local crisis centers 

that can then link callers to local emergency, mental health, and social services resources. In 

calendar year 2018, the National Suicide Prevention Lifeline answered calls from over 2.2 million 

Americans. 

In FY 2018, the Lifeline averaged 185,367 calls per month for a total of 2,224,408 calls answered. 

In FY 2019, call volume averaged 179,575 per month for a total of 2,154,903 calls answered.

Since FY 2007, SAMHSA has collaborated with the Department of Veterans Affairs (VA) to ensure 

that veterans, service members, and their families who call the Lifeline and “press 1” have 24/7 

access to the VA’s Veterans Crisis Line. 

SAMHSA evaluation studies have found that when a sample of suicidal callers who received 

follow-up calls from the Lifeline are asked, “...to what extent did calling the crisis hotline stop you 

from killing yourself?” A total of 82 percent responded either “a lot” (59 percent) or “a little” (22 

percent).

Lifeline evaluations have been the primary vehicle for collaborating with the crisis centers to adopt 

standards and guidelines based on evaluation results. These evaluation-driven standards and 

guidelines have, to date, focused on suicide risk assessment, imminent risk protocols, emergency 

intervention, and follow-up procedures and have advanced improvements in practice that are 
59

lifesaving. Hotline evaluation efforts will continue to focus on imminent risk and follow up for 

suicidal callers and suicidal persons accessing the crisis chat service. 

In addition, FY 2019 data for the Crisis Center Follow-up grant program indicates, 58,132 

individuals were screened for mental health and suicidal concerns of which 67.5 percent required 

services.

In FY 2018, SAMHSA awarded a new Suicide Lifeline grant and supported the continuation of six 

Crisis Center Follow-up grants. In FY 2019, SAMHSA supported the continuation of the Suicide 

Lifeline grant and provided $5.4 million in supplemental funding to enhance access to the Lifeline 

and strengthen the capacity of the Lifeline network to answer calls as rapidly as possible. In 

addition, SAMHSA awarded two new Crisis Center Follow-up grants to provide an integrated hub 

that: (1) ensures systematic follow-up of suicidal persons who contact a NSPL Crisis Center; (2) 

provides enhanced coordination of crisis stabilization, crisis respite, and hospital emergency 

department services; and (3) enhances coordination with mobile on-site crisis response. In effect, 

with the resources provided, the hub should not lose track of a person in a suicidal crisis as they 

interface with crisis systems. It is expected that this program will promote continuity of care to 

safeguard the well-being of individuals who are at risk of suicide.

In FY 2020, SAMHSA will fund the continuation of the Suicide Lifeline and provide $7 million in 

supplemental funding to continue to enhance and increase the capacity and strengthen the Lifeline 

Network especially in states with highest need. In addition, SAMHSA will fund the continuation 

of two Crisis Center Follow-up grants.

Funding History

Fiscal Year Amount

FY 2017 $7,198,000 

FY 2018 $7,198,000 

FY 2019 $12,000,000 

FY 2020 $19,000,000 

FY 2021 $19,000,000

Budget Request

The FY 2021 President’s Budget is $19.0 million, level with the FY 2020 Enacted level. SAMHSA 

is requesting funding for the continuation of the National Suicide Prevention Lifeline, which routes 

calls from anywhere in the country to a network of certified local crisis centers that can then link 

callers to local emergency, mental health, and social services resources. In addition, the funding 

will support the continuation of two National Suicide Prevention Lifeline Crisis Center Follow-up 

grants to focus on providing follow-up to suicidal people discharged from emergency rooms and 

inpatient units, and will support a crisis chat system. 
60

American Indian/Alaska Native Suicide Prevention Initiative

(Dollars in thousands)

Programs of Regional and National Significance

FY 

2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 

2020

American Indian/Alaska Native Suicide Prevention Initiative.. $2,931 $2,931 $2,931 $---

Authorizing Legislation ........................................... Section 520A of the Public Health Service Act

FY 2021 Authorization ................................................................................................. $394,550,000

Allocation Method ...............................................................................................................Contracts

Eligible Entities............................................................................................................Not applicable

Program Description and Accomplishments

The Tribal Training and Technical Assistance Center (Tribal TTA Center) is an innovative training 

and technical assistance project that helps tribal communities facilitate the development and 

implementation of comprehensive and collaborative community-based prevention plans to reduce 

violence, bullying, substance abuse, and suicide among American Indian/Alaska Native (AI/AN) 

youth. These plans mobilize tribal communities’ existing social and educational resources to meet 

their goals. 

From 2015 to 2019, 381 tribal communities have received specialized technical assistance and 

support in suicide prevention and related areas. In addition, more than 18,522 members of these 

communities received training in prevention and mental health promotion. 

In FY 2018, SAMHSA awarded a new contract to support this activity and awarded one Mental 

Health Transfer Technology Center (MHTTC) for Tribal Affairs to develop and maintain a 

collaborative network to support resource development and dissemination, training and technical 

assistance, and workforce development to the field and CMHS grant recipients. The MHTTC Tribal 

Affairs Center will coordinate and manage CMHS’s national efforts to ensure that high-quality, 

effective mental health disorder treatment and recovery support services, and evidence based 

practices are available for all individuals with mental disorders including, in particular, those with 

serious mental illness.

In FY 2019, SAMHSA continued support for this activity through the existing contract and the 

continuation of the MHTTC Tribal Affairs Center. In FY 2020, SAMHSA will fund the existing 

contract and the continuation of the MHTTC Tribal Affairs Center.
61

Funding History

Fiscal Year Amount

FY 2017 $2,931,000

FY 2018 $2,931,000

FY 2019 $2,931,000 

FY 2020 $2,931,000

FY2021 $2,931,000

Budget Request

The FY 2021 President’s Budget is $2.9 million, level with the FY 2020 Enacted level. This funding 

will support the continuation of the MHTTC Tribal Affairs Center and continuation of the contract 

to provide comprehensive, broad, focused, and intensive training and technical assistance to 

federally recognized tribes and other AI/AN, communities in order to address and prevent mental 

illness and alcohol/other drug addiction, prevent suicide, and promote mental health through the 

contract continuation.
62

Outputs and Outcomes Table

Program: Suicide Prevention

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

2.3.59 Number of individuals trained 

in youth suicide prevention 

(Outcome)

FY 2019: 226,573

Target: 77,306

(Target Exceeded)

226,573 226,573 Maintain

2.3.60 Number of youth screened 

(Output)

FY 2019: 195,547

Target: 62,542

(Target Exceeded)

195,547 195,547 Maintain

2.3.61 Number of calls answered by 

the suicide hotline (Output)

FY 2019: 2,154,903

Target: 1,877,020

(Target Exceeded)

2,154,903 2,154,903 Maintain

3.1.01 Number of individuals 

screened for mental health or related 

interventions (Intermediate 

Outcome)

FY 2019: 142,082.0

Target: 194,142.0

(Target Not Met)

142,082.0 142,082.0 Maintain

3.1.02 Number of individuals 

referred to mental health or related 

services (Intermediate Outcome)

FY 2019: 68,603.0

Target: 2,715.0

(Target Exceeded)

68,603.0 68,603.0 Maintain

3.1.03 Number of organizations that 

establish management 

information/information technology 

system links across multiple agencies 

(Intermediate Outcome)

FY 2019: 3.0

Target: 25.0

(Target Not Met)

3.0 3.0 Maintain

3.1.04 Number of organizations or 

communities that demonstrate 

improved readiness to change their 

systems (Intermediate Outcome)

FY 2019: 215.0

Target: Maintain Target

(Target Exceeded)

215.0 215.0 Maintain

3.2.37 Number of youth referred to 

mental health or related services 

(Output)

FY 2019: 30,362

Target: 13,950

(Target Exceeded)

30,362 30,362 Maintain

3.5.11 Number of respondents who 

say calling the lifeline stopped you 

from killing yourself a lot or a little 

(Outcome)

FY 2018: 82.0

Target: 82.0

(Baseline)

82.0 82.0 Maintain
63

Homelessness Prevention Programs

(Dollars in thousands)

Authorizing Legislation...............................Sections 520A of the Public Health Service Act

FY 2021 Authorization ................................................................................................ $394,550,000

Allocation Method ..............................................................................Competitive Grants/Contracts

Eligible Entities..........................................States, Domestic Public and Community Organizations,

Private Nonprofit Entities, and Community-based Public or Nonprofit Entities

Program Description and Accomplishments

While significant progress has been made over the last decade to reduce homelessness in specific 

communities and with specific populations, the number of people experiencing homelessness has 

remained relatively flat between 2017 and 2018, increasing by just 0.3 percent or (1,834 people). 

The slight increase in overall homelessness can be attributed to an increase in the number of 

unsheltered individuals. Many factors contribute to homelessness, including lack of affordable 

housing, foreclosures, rising housing costs, job loss, underemployment, mental illness, and 

addiction. Services are needed to link individuals to permanent housing and coordinate benefits, 

treatment, and supportive services. According to the U.S. Department of Housing and Urban 

Development, 552,830 individuals experienced homelessness on a given night in 2018 in the United 

States. The number of individuals experiencing chronic homelessness increased by two percent (or 

by 1,935 people) between 2017 and 2018. The number of veterans experiencing homelessness 

decreased by five percent (or 2,142 people) between 2017 and 2018. 17 About 20 percent of 

individuals experiencing homelessness have an SMI and 15 percent struggle with chronic substance 

use and misuse.18

In FY 2018, SAMHSA initiated the CMHS-funded Treatment for Individuals Experiencing 

Homelessness (TIEH) program, to support the development and/or expansion of the local 

implementation of an infrastructure that integrates behavioral health treatment and recovery support 

services for individuals, youth, and families with a serious mental illness, serious emotional 

disturbance, or co-occurring disorder (i.e., a serious mental illness [SMI] and substance use disorder 

[SUD] or a serious emotional disturbance [SED] and SUD) who are experiencing homelessness.

The goal of this program is to increase capacity and provide accessible, effective, comprehensive, 

coordinated, integrated, and evidence-based treatment services, peer support and other recovery 

support services, and linkages to sustainable permanent housing.

 17 The 2018 Annual Homeless Assessment Report (AHAR) to Congress. (December 2018.). Retrieved December 9, 

2019, from https://www.hudexchange.info/resources/documents/2017-AHAR-Part-1.pdf 18 The U.S. Department of Housing and Urban Development, 2017 CoC Homeless Populations and Subpopulations 

Reports. Available at https://www.hudexchange.info/resource/reportmanagement/published/CoC_PopSub_NatlTerrD

C_2017.pdf

Programs of Regional and National Significance

FY 2019

 Final

FY 2020 

Enacted

 FY 2021

President's 

Budget

FY 2021 

+/-

 FY 2020

Total Homelessness................................................................................ $32,992 $32,992 $32,992 $---

Homelessness Prevention Programs................................................. 30,696 30,696 30,696 ---

Homelessness....................................................................................... 2,296 2,296 2,296 ---
64

FY 2019 data show that at six-month follow-up, 40 percent of individuals reported positive 

functioning; 28 percent were employed; and 40 percent had a permanent place to live. SAMHSA

also supported a technical assistance contract to provide training and support to the general public, 

constituent groups, service providers, grantees, and other stakeholders. 

In FY 2018, SAMHSA supported 46 Cooperative Agreement to Benefit Homeless Individuals 

(CABHI) continuation grants, 24 new TIEH grants, and technical assistance activities. In FY 2019, 

SAMHSA supported 16 CABHI and 24 TIEH grant continuations, awarded 19 new TIEH grants, 

and technical assistance activities. In FY 2020, SAMHSA will fund 43 TIEH continuation grants, 

five new TIEH grants, and technical assistance activities. 

 Funding History

Fiscal Year Amount

FY 2017 $32,992,000

FY 2018 $32,992,000

FY 2019 $32,992,000

FY 2020 $32,992,000

FY 2021 $32,992,000

Budget Request

The FY 2021 President’s Budget is $32.9 million, level with the FY 2020 Enacted level. With this 

funding SAMHSA will support 48 continuation grants and technical assistance activities to increase

capacity and provide accessible, effective, comprehensive, coordinated, integrated, and evidencebased treatment services, peer support and other recovery support services, and linkages to 

sustainable and permanent housing.
65

Outputs and Outcomes Table

Program: Homelessness Prevention Programs

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

3.4.23 The number of clients served 

(Output)

FY 2019: 3521

Target: 4600

(Target Not Met)

3521 3521 Maintain

3.4.24 Percentage of homeless clients 

receiving services who were currently 

employed or engaged in productive 

activities (Outcome)

FY 2019: 34.4 %

Target: 20 %

(Target Exceeded)

34.4 % 34.4 % Maintain

3.4.25 Percentage of clients receiving 

services who had a permanent place to 

live in the community (Outcome)

FY 2019: 31.1 %

Target: 70 %

(Target Not Met)

31.1 % 31.1 % Maintain
66

Minority AIDS 

(Dollars in thousands)

Programs of Regional and National Significance

FY 

2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 

2020

Minority AIDS............................................................................

 

9,224 

 

9,224 

 

9,224 $---

Authorizing Legislation ........................................... Section 520A of the Public Health Service Act

FY 2021 Authorization ................................................................................................. $394,550,000

Allocation Method .....................................Competitive Grants/Contracts/Cooperative Agreements

Eligible Entities.......................................Community and faith-based organizations, Tribes, Urban, 

Indian organizations, Hospitals, Public and private universities and colleges

Program Description and Accomplishments

The Minority AIDS Initiative - Service Integration grant is designed to meet the health needs of 

some of America’s most vulnerable. Adults with Serious Mental Illness (SMI) receiving public 

specialty mental health services are not tested for HIV regularly (Mangurian, 2017). MAI-SI makes 

HIV testing and treatment, PrEP and PEP, and Hepatitis vaccination and treatment available to this 

underserved population. Some grantees are HIV/AIDS providers expanding mental health services 

to their clients. Others, mental health providers bring HIV/AIDS services to their clients. 

The Centers for Disease Control and Prevention (CDC) reports significantly higher rates of 

HIV/AIDS among racial/ethnic minorities compared with the general population.19 Only 

approximately 7 percent of people with severe mental illness receive HIV testing. Significant racial 

disparities: Asians/Pacific Islanders were 53 percent less likely and blacks were 82 percent more 

likely to be tested (ibid). African Americans accounted for 45 percent and Hispanics accounted for 

23 percent of all HIV/AIDS cases diagnosed in 2013.20 Psychiatric and psychosocial complications 

are frequently not diagnosed nor addressed at the time of HIV diagnosis or through the course of 

the disease process. When untreated, these complications are associated with increased morbidity 

and mortality, impaired quality of life, and numerous medical issues such as non-adherence with 

the treatment regimen. 

The Minority AIDS program enhances and expands the provision of effective, culturally competent, 

HIV/AIDS-related mental health services in racial and ethnic minority communities for people 

living with or at high risk for HIV/AIDS. More than 4,600 individuals received services in 

FY 2017. The MAI program, along with many other HIV/AIDS programs across HHS, contributes 

to the goals of a new initiative to eliminate new HIV infections in our nation. Ending the HIV 

Epidemic: A Plan for America will be supported by this program through its continued assistance 

to vulnerable populations.

 19 Centers for Disease Control and Prevention. HIV Surveillance Report. (2013); vol. 25. Published February 2015. 

Accessed May 8, 2015 from http://www.cdc.gov/hiv/library/reports/surveillance. 20 Centers for Disease Control and Prevention. HIV Surveillance Report. (2013); vol. 25. Published February 2015. 

Accessed May 8, 2015 from http://www.cdc.gov/hiv/library/reports/surveillance.
67

In FY 2018, SAMHSA awarded a new cohort of 18 grants focused on integrated evidence-based, 

culturally competency mental and substance use disorder treatment with HIV primary care and 

prevention services. The population of focus is individuals with a serious mental illness or cooccurring disorder living with or at risk for HIV and/or hepatitis in at-risk populations, including 

racial and ethnic minority communities. The expected outcome from this grant program is to reduce 

the incidence of HIV and improve overall health outcomes for individuals with Serious Mental 

Illness or co-occurring disorder. 

Required activities under this grant include HIV and hepatitis prevention services to include 

screening, risk assessment, prevention counseling, rapid testing, PrEP and hepatitis vaccination 

within a behavioral health setting. Provide evidence-based mental and substance use disorder 

treatment and practices that are trauma-informed and recovery-oriented. Implement outreach 

strategies to inform individuals of available behavioral health services and HIV and hepatitis 

primary care and prevention services. Offer peer support and case management services to 

coordinate all aspects of care. 

Grantees collect data at baseline, 6-month reassessment, and discharge. FY 2019 reassessment data 

show 53 percent of individuals receiving services are not experiencing serious psychological 

distress; 62 percent reported an increase in everyday functioning; and 29 percent of individuals 

were being retained in the community. 

In FY 2019, SAMHSA continued support for 18 continuations grants. In FY 2020, SAMHSA will 

fund 18 continuation grants. 

 Funding History

Fiscal Year Amount

FY 2017 $9,224,000

FY 2018 $9,224,000

FY 2019 $9,224,000

FY 2020 $9,224,000

FY 2021 $9,224,000

Budget Request

The FY 2021 President’s Budget is $9.2 million, level with the FY 2020 Enacted level. SAMHSA 

will support 18 continuations grants focused on individuals with mental disorders and/or cooccurring disorders living with or at risk for HIV/AIDS.
68

Outputs and Outcomes Table

Program: Minority AIDS Initiative Service Integration

Measure

Year and Most Recent Result

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

3.5.02 Percentage of clients receiving 

services who report positive 

functioning at 6 month follow-up. 

(Outcome)

FY 2019: 62.1

Target: 75.0

(Target Not Met)

62.1 62.1 Maintain

3.5.03 Percentage of clients receiving 

services who had a permanent place 

to live in the community at sixmonth follow-up. (Outcome)

FY 2019: 58.8

Target: 39.0

(Target Exceeded)

58.8 58.8 Maintain

3.5.04 Percentage of clients receiving 

services who are currently employed 

at six-month follow-up. (Outcome)

FY 2019: 35.5

Target: 39.0

(Target Not Met)

35.5 35.5 Maintain
69

Criminal and Juvenile Justice Programs

(Dollars in thousands)

 

Programs of Regional and National Significance

FY 

2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 

2020

Criminal and Juvenile Justice Programs...................................... $4,269 $6,269 $9,269 $---

Authorizing Legislation..............................Sections 520G of the Public Health Service Act

FY 2021 Authorization ..................................................................................................... $4,269,000

Allocation Method ..............................................................................Competitive Grants/Contracts

Eligible Entities......................Tribal Court Administrator, the Administrative Office of the Courts, 

the Single State Agency for Alcohol and Drug Abuse, the State Mental 

Health Agency, the Designated State Drug Court Coordinator, and 

Local Governmental Unit

Program Description and Accomplishments

Data indicate that a significant number of individuals that come in contact with law enforcement 

and the criminal justice system have a mental or substance use disorder. More than half of all prison 

and jail inmates (i.e., people in state and federal prisons and local jails) meet criteria for having a 

mental health problem; 6 in 10 meet criteria for a substance abuse problem; and more than onethird meet criteria for having both a substance abuse and mental health problem.21 Approximately 

250,000 individuals with serious mental illness (SMI) are incarcerated at any given time—about 

half arrested for non-violent offenses, such as trespassing or disorderly conduct. In addition, during 

street encounters, police officers are almost twice as likely to arrest someone who appears to have 

a mental illness. A Chicago study of thousands of police encounters found that 47 percent of people 

with a mental illness were arrested, while only 28 percent of individuals without a mental illness 

were arrested for the same behavior.22 The costs associated with incarceration are high: state 

corrections budgets alone account for $39.0 billion in taxpayer costs.23,24 There is a clear and largely 

unmet need for effective behavioral health services and supports that are accessible before, during, 

and after incarceration and continue in the community as needed for this high-risk, population. 

SAMHSA completed an evaluation of the first cohort of Behavioral Health Treatment Courts 

Collaborative (BHTCC) grantees in September 2014. Findings of the evaluation demonstrate that 

grantees built multi-agency workgroups or collaborative to oversee programs. Because of the grant 

funding, all grant recipients expanded access to specialty courts. Most grant recipients anticipated 

 21 U.S. Department of Justice, Office of Justice Programs. (2006) Mental health problems of prison and jail inmates. 

Retrieved, March 25, 2011, from http://bjs.ojp.usdoj.gov/content/pub/pdf/mhppji.pdf 22 The Role of Mental Health Courts in System Reform. The Bazelon Center for Mental Health Law. 

http://heinonline.org/HOL/LandingPage?handle=hein.journals/udclr7&div=10&id=&page= 23 Pew Center on the States. (2011). State of recidivism: The revolving door of America’s prisons. Washington, DC: 

The Pew Charitable Trusts. http://www.pewtrusts.org/en/research-and-analysis/reports/0001/01/01/state-of-recidivism 24 Henrichson, C., & Delaney, R. (2012). The price of prisons: What incarceration costs taxpayers. New York: Vera 

Institute of Justice.
70

continuing new screening and assessment processes addressing a broader array of behavioral health 

needs after grant funding ended. Program innovations were divided into four main groups, 

including court and treatment provider collaboration, court and community case management, 

unified cross-court screening and referral, and meaningful peer involvement. BHTCC served over 

2,99717 individuals, with 77 percent of them identified as having co-occurring mental illness and 

drug/alcohol addiction and with nearly two thirds reporting violence or trauma exposure in their 

lives. Based on performance data reporting, alcohol and other drug use by program participants 

declined by 53 percent at six months18. Nearly 79 percent of participants either maintained good 

physical health or reported physical health improvements in the same time period. In addition, 

employment rates increased from 29 percent to 45 percent over the first six months, with monthly 

mean income increasing by $217.

In FY 2019, Early Diversion grantees screened over 1,400 clients and referred over 1,000 

individuals to mental health services.

In FY 2018, SAMHSA awarded a new cohort of 12 Law Enforcement Behavioral Health 

Partnerships for Early Diversion (Short Title: Early Diversion) grants, which divert adults with an 

SMI or a co-occurring disorder from the criminal justice system to community-based services prior 

to arrest and booking. In addition, SAMHSA continued support for the technical assistance and 

evaluation contracts. In FY 2019, SAMHSA continued support for 11 Early Diversion grant 

continuations grants and technical assistance and evaluation activities. In FY 2020, SAMHSA will 

fund 11 continuation grants, award a new cohort of six grants, and technical assistance activities. 

Funding History

Fiscal Year Amount

FY 2017 $4,269,000

FY 2018 $4,269,000

FY 2019 $4,269,000

FY 2020 $6,269,000

FY 2021 $9,269,000

Budget Request

The FY 2021 President’s Budget is $9.2 million, an increase of $3.0 million from the FY 2020 

Enacted level. SAMHSA will support the continuation of 17 grants, award a new cohort of eight 

grants and a new technical assistance center. The increased funding will specifically address the 

needs of those with Serious Mental Illness. Individuals with SMI are more likely to become 

involved in the criminal justice system than those with mental illness. Focusing on SMI will reduce 

 17Cohort 2 data through November 15, 201718 Calculated as the change in percentage of individuals reporting alcohol 

or drug use from baseline to six-month follow-up. 18 Calculated as the change in percentage of individuals reporting alcohol or drug use from baseline to six-month followup.
71

costly and counterproductive involvement in the criminal justice system and support better 

outcomes for these individuals by connecting them with needed services.
72

Outputs and Outcomes Table

Program: Criminal and Juvenile Justice

Measure

Year and Most Recent Result

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

3.5.06 Percentage of clients receiving 

services who report positive 

functioning at 6 month follow-up 

(Outcome)

FY 2019: 47.6

Target: 50.0

(Target Not Met)

47.6 50 +2.4%

3.5.07 Percentage of clients receiving 

services who had a permanent place to 

live in the community at six-month 

follow-up. (Outcome)

FY 2019: 23.8

Target: 50.0

(Target Not Met)

23.8 50 +26.8%

3.5.09 Number of individuals 

screened for mental health or related 

interventions. (Output)

FY 2019: 1,438.0

Target: 945.0

(Target Exceeded)

1,438.0 4,745 +3,307
73

Practice Improvement and Training

(Dollars in thousands)

Programs of Regional and National Significance

FY 

2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 

2020

Practice Improvement and Training............................................ $7,828 $7,828 $7,828 $---

Authorizing Legislation ........................................... Section 520A of the Public Health Service Act

FY 2021 Authorization ................................................................................................ $394,550,000

Allocation Method ..............................................................................Competitive Grants/Contracts

Eligible Entities...............105 Nationally Recognized Historically Black Colleges and Universities

Program Description and Accomplishments

SAMHSA facilitates health integration by engaging in activities that support mental health system 

transformation. The Practice Improvement and Training programs address the need for 

disseminating key information, such as evidence-based mental health practices, to the mental health 

delivery system.

The purpose of the Historically Black Colleges and Universities-Center for Excellence (HBCUCFE) program is to network the 105 HBCUs throughout the United States and promote behavioral 

health workforce development through expanding knowledge of best practices, developing 

leadership, and encouraging community partnerships that enhance the participation of African 

Americans in substance use disorder treatment and mental health professions. The comprehensive 

focus of the HBCU-CFE program simultaneously expands service capacity on campuses and in 

other treatment venues. 

SAMHSA has worked to strengthen its clinical and science-based approach to addressing serious 

mental illness. In FY 2018, SAMHSA developed a Clinical Support Services TA Center to address 

SMI. This TA Center focuses specifically on the clinical treatment of SMI, including the use of 

medications. 

In FY 2019, SAMHSA continued support for the HBCU grant program and the Clinical Support 

Services TA Center. In FY 2020, SAMHSA will fund the HBCU grant program and the Clinical 

Support Services TA Center.
74

Funding History

Fiscal Year Amount

FY 2017 $7,828,000 

FY 2018 $7,828,000 

FY 2019 $7,828,000 

FY 2020 $7,828,000 

FY 2021 $7,828,000

Budget Request

The FY 2021 President’s Budget is $7.8 million, level with the FY 2020 Enacted level. Funding 

will support the continuation of the HBCU program, the continuation of the Clinical Support 

Services TA Center for SMI. 

The output and outcome measures for Practice Improvement and Training are part of the Mental 

Health - Science and Service Activities Outputs and Outcomes table shown on page 69.
75

Consumer and Consumer-Supporter TA Centers

(Dollars in thousands)

Programs of Regional and National Significance

FY 

2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 

2020

Consumer and Consumer-Supporter Technical Assistance 

Centers.. $1,918 $1,918 $1,918 $---

Authorizing Legislation ........................................... Section 520A of the Public Health Service Act

FY 2021 Authorization ................................................................................................. $394,550,000

Allocation Method ...............................................................................................Competitive Grants

Eligible Entities........................................................................................ Community Organizations

Program Description and Accomplishments

Consumer-centered services and supports, such as peer specialists, are vital to improving the quality 

and outcomes of health and behavioral healthcare services for people with mental disorders 

including SMI. First funded in 1992, the purpose of Consumer and Consumer-Supporter Technical 

Assistance (TA) Centers is to provide technical assistance to facilitate quality improvement of the 

mental health system by specific promotion of consumer-directed approaches for adults with SMI. 

Such approaches maximize consumer self-determination, promote long-term recovery, and assist 

individuals with SMI to increase their community involvement through work, school, and social 

connectedness. This program also improves collaboration among consumers, families, providers, 

and administrators. It helps to transform community mental health services into a more consumer 

and family driven model. 

In FY 2019, the Consumer and Consumer-Supporter TA Centers provided training to 

approximately 16,000 people. These trainings covered a range of topics, including peer support, 

the Wellness Recovery Action Plan, Emotional CPR, financial literacy, and collaborative 

leadership. In addition, the Consumer and Consumer-Supporter TA Centers provided support and 

expertise to consumer organizations that led to these organizations obtaining over $2.62 million in 

funding (non-grant). Due to this grant, 162 consumers and family members holding positions 

within consumer or family organizations participated in mental health-related planning and 

systems improvement.

In FY 2018, and FY 2019 SAMHSA supported the continuation of five grants. In FY 2020, 

SAMHSA anticipates funding a new cohort of five grants.
76

Funding History

Fiscal Year Amount

FY 2017 $1,918,000

FY 2018 $1,918,000

FY 2019 $1,918,000

FY 2020 $1,918,000

FY 2021 $1,918,000

Budget Request

The FY 2021 President’s Budget is $1.9 million, level with the FY 2020 Enacted level. 

SAMHSA’s funding request will support five continuation grants to provide technical assistance to 

facilitate the quality improvement of the mental health system by promoting consumer-directed 

approaches for adults with SMI.

The output and outcome measures for Consumer and Consumer-Supporter TA Centers are part of 

the Mental Health - Science and Service Activities Outputs and Outcomes table shown on page 69.
77

Disaster Response

(Dollars in thousands)

Programs of Regional and National Significance

FY 

2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 

2020

Disaster Response....................................................................... $1,953 $1,953 $1,953 $---

Authorizing Legislation ........................................... Section 520A of the Public Health Service Act

FY 2021 Authorization ................................................................................................ $394,550,000

Allocation Method ..............................................................................Competitive Grants/Contracts

Eligible Entities........................................................ Domestic Public or Private Non-Profit Entities

Program Description and Accomplishments

Natural and human caused disasters and emergent events like hurricanes, wildfires, floods, 

tornados, and mass shootings; strike without warning. These unexpected disasters and events leave 

individuals, families, and whole communities struggling to rebuild. 

 

SAMHSA helps ensure that the nation is prepared to address the behavioral health needs that follow 

these disasters or events. SAMHSA focuses on three major programs: the Crisis Counseling 

Assistance and Training Program (CCP), the Disaster Distress Helpline (DDH), and Disaster 

Behavioral Health. These programs use appropriated funds to support survivors of natural and 

man-made disasters. 

SAMHSA, through an interagency agreement with the Federal Emergency Management Agency 

(FEMA), operates the CCP. This program assists individuals and communities in recovering from 

presidentially declared disasters through the provision of community-based behavioral health 

outreach and psycho-educational services. SAMHSA provides technical assistance, program 

guidance and monitoring, and oversight of the CCP. SAMHSA and FEMA jointly fund a Disaster 

Technical Assistance Center (DTAC) designed to provide additional technical assistance, strategic 

planning, consultation, and logistical support. SAMHSA provides Disaster Behavioral Health 

expertise around emerging public health initiatives to develop and disseminate innovative 

consultation and technologies to communities, federal partners, and other stakeholders.

In FY 2019, the CCP Online Data Collection and Evaluation System showed the following contacts 

and encounters funded by 36 CCP grants: 

• 978,267 in-person brief educational supportive contacts; 

• 57,641telephone contacts and 30,847 e-mail contacts. 

• 229,303 individual and family crisis counseling encounters (lasting 15 to 60 minutes or 

more) serving 306,508 individuals; and 

• 19,099 group encounters (public education and group counseling) serving 413,643 

individuals. 
78

Individual and family crisis counseling encounters were most often conducted with adults ages 40 

to 64 (43 percent) followed by adults ages 65 and older (31 percent) and children and adults ages 

18-39 (16 percent). Individual and family encounters occurred most often with female (57 percent) 

disaster survivors and most (66 percent) were conducted in Spanish due to the large CCP grant 

running in Puerto Rico. The five most common risk factors reported by counseling participants 

were other financial loss (23 percent), home damaged or destroyed (17 percent), vehicle or major 

property loss (9 percent), past trauma (10 percent), and preexisting physical disability (8 percent). 

Across the four major health concern categories (behavioral, emotional, physical, and cognitive), 

the highest number of reported disaster event reactions fell within the emotional category and 

included "anxious, fearful" (n = 123,747) and "sadness, tearful" (n =101,632). The next most 

prevalent reaction was “preoccupied with death/destruction” (n= 90,366) under the cognitive 

category.

SAMHSA’s Disaster Distress Helpline is a toll-free, multilingual crisis systems service available 

24/7 via telephone (1-800-985-5990) and Short Message Service (SMS) (text ‘TalkWithUs’ to 

66746) to residents in the United States and its territories who are experiencing emotional distress 

resulting from disasters. In FY 2018, SAMHSA responded to over 11,800 calls and received over 

18,400 text messages through these services. In FY 2014, SAMHSA’s first Disaster app was 

created on Apple and Android platforms. The Disaster App provided evidence-informed and 

evidence-based resources in the Disaster Kit, along with additional partner resources and 

information on local mental health and substance use treatment facilities. It has the ability to share 

content anonymously and can function with limited Internet connectivity.

In FY 2018, SAMHSA awarded a new jointly funded National Suicide Prevention Lifeline and 

National Disaster Distress Helpline and continued support for the DTAC. 

In FY 2019, SAMHSA continued support for the National Disaster Distress Helpline and awarded 

a new DTAC contract. In FY 2020, SAMHSA anticipates funding the National Disaster Distress 

Helpline and the DTAC contract. 
79

 Funding History

Fiscal Year Amount

FY 2017 $1,953,000

FY 2018 $1,953,000

FY 2019 $1,953,000

FY 2020 $1,953,000

FY 2021 $1,953,000

Budget Request

The FY 2021 President’s Budget is $1.9 million, level with the FY 2020 Enacted level. SAMHSA 

is requesting funding to continue support for the National Disaster Distress Helpline and the 

Disaster Technical Assistance Center.

The output and outcome measures for Disaster Response are part of the Mental Health - Science 

and Service Activities Outputs and Outcomes table shown on page 69.
80

Seclusion and Restraint

(Dollars in thousands)

Programs of Regional and National Significance

FY 

2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 

2020

Seclusion and Restraint.............................................................. $1,147 $1,147 $1,147 $---

Authorizing Legislation ........................................... Section 520A of the Public Health Service Act

FY 2021 Authorization ................................................................................................. $394,550,000

Allocation Method ...............................................................................................................Contracts

Eligible Entities.......................................................................................................... Not Applicable

Program Description and Accomplishments

People die because of the inappropriate use of seclusion and restraint practices; countless others are 

injured; and many are traumatized by coercive practices. Children with emotional and behavioral 

issues are more frequently subjected to restraints in schools than students with other disabilities, 

often leading to serious physical injuries and emotional trauma for both students and staff. Coercive 

practices, such as seclusion and restraint, impede recovery and well-being. 

In FY 2018, SAMHSA has utilized funding to contribute to a regionally-based TA effort focusing 

on issues related to the provision of services and supports for those living with mental disorders 

and/or SMI. 

In FY 2019, SAMHSA supported the continuation for the 11 MHTTC grants. In FY 2020, 

SAMHSA will fund 11 MHTTC continuation grants. 

 Funding History

Fiscal Year Amount

FY 2017 $1,147,000

FY 2018 $1,147,000

FY 2019 $1,147,000

FY 2020 $1,147,000

FY 2021 $1,147,000

Budget Request

The FY 2021 President’s Budget is $1.1 million, level with the FY 2020 Enacted level. SAMHSA’s 

funding request will provide support for the continuation of the 11 MHTTC grants.
81

Assertive Community Treatment for Individuals with Serious Mental Illness

(Dollars in thousands)

Programs of Regional and National Significance

FY 

2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 

2020

Assertive Community Treatment for Adults with SMI..... $5,000 $7,000 $25,000 $18,000 

Authorizing Legislation ....................................Sections 520M of the Public Health Service Act

FY 2021 Authorization ....................................................................................................$5,000,000

Allocation Method ..............................................................................Competitive Grants/Contracts

Eligible Entities...............................States, local governments, Indian tribes or tribal organizations, 

mental health systems, or health care facilities

Program Description and Accomplishments

The Assertive Community Treatment (ACT) for Individuals with SMI program is authorized under 

the 21st Century Cures Act. ACT is an evidence-based practice considered to be one of the most 

effective approaches to deliver services to individuals with the most severe impairments associated 

with SMI25 and has been disseminated by SAMHSA for widespread use through its Evidence-based 

Toolkit series26 beginning in 2008. ACT was developed to reduce re-hospitalization and improve 

outcomes in community settings. ACT is designed as an integrated care approach to provide a 

comprehensive array of services, including medication management and other supportive services, 

directly rather than through referrals. The ACT team is composed of 10-12 multidisciplinary 

behavioral health staff, including psychiatrists, nurses, social workers, addiction counselors, 

employment/vocational supports, and peer specialists. These practitioners work together to deliver 

comprehensive, individualized, and recovery-oriented treatment and case management services to 

approximately 100 people with SMI in community settings. Caseloads are approximately one staff 

member to every 10 individuals. Services are provided 24 hours, 7 days a week and as long as 

needed, wherever they are needed. Teams often find they can anticipate and avoid crises. 

In FY 2018, SAMHSA awarded seven new grants to develop and/or expand fidelity-based ACT 

services to meet the needs of individuals with SMI, and reduce hospitalization, homelessness, and 

involvement in the criminal justice system while improving health and social outcomes of 

participants in the program. 

FY 2019 data indicated that the number of individuals served by the program who used emergency 

rooms for behavioral health concerns decreased 22 percent, the number of individuals who were 

homeless decreased 18.8 percent, and the rate of improvement in social connectedness increased 

by almost 50 percent. Data also showed that 598 individuals received evidence-based mental health 

related services and 426 individuals in the mental health workforce received training in mental 

health practices consistent with the goals of the program. 

 25 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3589962/ 26 http://store.samhsa.gov/product/Assertive-Community-Treatment-ACT-Evidence-Based-Practices-EBPKIT/SMA08-4345
82

In FY 2019, SAMHSA supported seven continuation grants. In FY 2020, SAMHSA will fund 

seven continuation grants and award two new ACT grants. 

Funding History

Fiscal Year Amount

FY 2017 $---

FY 2018 $ 5,000,000 

FY 2019 $ 5,000,000 

FY 2020 $ 7,000,000 

FY 2021 $25,000,000

Budget Request 

FY 2021 President’s Budget is $25.0 million, an increase of $18.0 million from the FY 2020 

Enacted level. This funding will support a new cohort of 24 grants and the continuation of nine 

grants to advance the ACT approach to address the needs of those living with SMI. 
83

Outputs and Outcomes Table

Program: Assertive Community Treatment Grants

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

3.4.13 Percentage of clients receiving 

services who report positive 

functioning at 6 month follow-up. 

(Outcome)

FY 2019: 49.4

Target: 66.0

(Target Not Met)

49.4 66 +16.6%

3.4.14 Percentage of clients receiving 

services who are currently employed 

at 6 month follow-up. (Outcome)

FY 2019: 28.2

Target: 39.0

(Target Not Met)

28.2 39 +10.8%

3.4.15 Percentage of clients receiving 

services who have a permanent place 

to live in the community at 6 month 

follow-up. (Outcome)

FY 2019: 60.7

Target: 74.0

(Target Not Met)

60.7 74 +13.3%
84

Assisted Outpatient Treatment for Individuals with Serious Mental Illness

(Dollars in thousands)

Programs of Regional and National Significance

FY 

2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 

2020

Assisted Outpatient Treatment for Individuals with Serious 

Mental Illness.. $15,000 $19,000 $25,000 $6,000 

Authorizing Legislation .................Section 224 of the Protecting Access to Medicare Act of 2014,

FY 2021 Authorization ................................................................................................... $18,000,000

Allocation Method ..............................................................................Competitive Grants/Contracts

Eligible Entities..................................................................States and communities

Program Description and Accomplishments

Recent data show that one in 25 Americans live with a SMI, such as schizophrenia, bipolar disorder 

and major depression. Less than half of adults with diagnosable mental disorders receive the 

treatment they need. Without access to and receipt of evidence-based mental health services, 

mental health issues can negatively affect all areas of a person’s life.

In an effort to increase access to evidence-based mental health services for individuals with SMI, 

in April 2014, Congress passed the Protecting Access to Medicare Act of 2014 (PAMA), which 

authorized a four-year pilot program to award grants for Assisted Outpatient Treatment (AOT) 

programs for individuals with SMI. This authorization was extended in the 21st Century Cures Act. 

AOT is the practice of delivering outpatient treatment under court order to adults with SMI who 

meet specific criteria, such as a prior history of non-adherence to treatment repeated hospitalizations 

or arrest. AOT involves petitioning local courts through a civil process to order individuals to enter 

and remain in treatment within the community for a specified period of time. This program will 

help to identify evidence-based AOT practices that support improved outcomes, including outreach 

and engagement, clinical treatment and supportive services, and due process protections. 

In FY 2016, SAMHSA implemented the AOT grant program and awarded 17 grants to eligible 

entities, such as a county, city, mental health system, mental health court, or any other entity with 

authority under the law of the state in which the grantee is located. This four-year pilot program is 

intended to implement and evaluate new AOT programs and identify evidence-based practices in 

order to reduce the incidence and duration of psychiatric hospitalization, homelessness, 

incarcerations, and interactions with the criminal justice system while improving the health and 

social outcomes of individuals with a SMI. This program is designed to work with families and 

courts to allow these individuals to obtain treatment while continuing to live in the community and 

their homes. Grants were awarded to applicants that have not previously implemented an AOT 

program. 

SAMHSA will continue to consult with the National Institute of Mental Health, the Attorney 

General, and the Administration for Community Living on this pilot program. In addition, 

SAMHSA will work with families and courts in the implementation of this program. 
85

Grantee performance data from SAMHSA’s Performance Accountability Reporting System 

(SPARS) was used to capture outcomes in the four areas listed below: 

1. Cost savings and public health outcomes including substance abuse, hospitalization, and use 

of services

• 9.8 percent of AOT program participants reported spending at least one day in the 

hospital for mental health care in the past 30 days at their most recent reassessment 

compared to 65.3 percent at intake.

• 7.3 percent of AOT program participants reported spending at least one day in the 

emergency department for a psychiatric or emotional problem in the past 30 days at 

their most recent reassessment compared to 33.2 percent at intake.

• 25 percent of AOT program participants reported using illegal substances 30 days 

before their most recent reassessment compared to 33.3 percent at intake. 

2. Rates of Incarceration

• 7.1 percent of AOT program participants reported spending one or more nights in a 

correctional facility in the past 30 days at their most recent reassessment compared to 

12.7 percent at intake. 

3. Rates of Homelessness 

• 7.0 percent of AOT program participants reported spending one or more homeless 

nights in the past 30 days at their most recent reassessment compared to 13.6 percent 

at intake.

4. Patient and family satisfaction with program participation

• 91.8 percent of AOT program participants agreed or strongly agreed with the 

statement “I liked the services I received here” at their most recent reassessment. 

In FY 2018, SAMHSA supported 15 continuation grants, 3 new grants, and technical assistance 

and evaluation activities. In FY 2019, SAMHSA funded 18 continuation grants. In FY 2020, 

SAMHSA anticipates funding a new cohort of 15 grants and four continuation grants.
86

Funding History

Fiscal Year Amount

FY 2017 $15,000,000

FY 2018 $15,000,000

FY 2019 $15,000,000

FY 2020 $19,000,000

FY 2021 $25,000,000

Budget Request

The FY 2021 President’s Budget is $25.0 million, an increase of $6.0 million from the FY 2020 

Enacted level. This funding will support a new cohort of six grants and 18 grant continuations to 

improve the health and social outcomes for individuals with SMI. 
87

Outputs and Outcomes Table 

Program: Assisted Outpatient Treatment for Individuals with Serious Mental Illness

Measure

Year and Most Recent Result 

Target for Recent Result

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

3.4.06 Percentage of clients receiving 

services who report positive 

functioning at 6 month follow-up. 

(Outcome)

FY 2019: 70.3

Target: 72.3

(Target Not Met)

70.3 72.3 +2.0%

3.4.07 Percentage of clients receiving 

services who are maintained at sixmonth follow-up. (Outcome)

FY 2019: 80.9

Target: 82.3

(Target Not Met)

80.9 82.3 +1.4%

3.4.08 Number of people in the mental 

health and related workforce trained 

in mental health-related 

practices/activities. (Output)

FY 2019: 2,180.0

Target: 2,519.0

(Target Not Met)

2,180.0 3,618 +1,439

3.4.09 Number of consumers/family 

members who provide mental healthrelated services. (Output)

FY 2019: 67.0

Target: 94.0

(Target Not Met)

67.0 111 +44

* Trained consumer/family members providing mental health-related services can assist in the attainment of 

treatment goals and promote improved role functioning in the home and in community settings. The number of 

consumers/family members providing mental-health related services reflects the AOT program’s access to these 

services, which could be a potential indicator of overall positive AOT outcomes for individuals with serious mental 

illness.
88

Outputs and Outcomes Table

Program: Mental Health – Other Capacity Activities 1

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

3.5.00 Number of people in the mental 

health and related workforce trained in 

mental health-related practices/activities 

that are consistent with the goals of the 

grant (Output)

FY 2019: 13,370.0

Target: 10,349.0

(Target Exceeded)

13,370.0 13,370.0 Maintain

3.5.01 Number of consumers/family 

members representing consumer/family 

organizations who are involved in 

ongoing mental health-related planning 

and advocacy activities as a result of the 

grant (Output)

FY 2019: 6,987.0

Target: 11,536.0

(Target Not Met)

6,987.0 6,987.0 Maintain

1 Includes the following: Children and Family, Consumer and Family Network, Consumer and Consumer-Supporter 

TA Centers, Practice Improvement Training, and Disaster Response.
89

Outputs and Outcomes Table

Program: Mental Health - Science and Service Activities

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

1.4.06 Number of people 

trained by CMHS Science and 

Service Programs (Output)

FY 2019: 19,356

Target: 46,113

(Target Not Met)

19,356 19,356 Maintain

1.4.14 Number of calls 

answered by the Disaster 

Distress Hotline (Output)

FY 2019: 11,820

Target: 10,732

(Target Exceeded)

11,820 11,820 Maintain

1.4.15 Number of text 

messages answered by the 

Disaster Distress Hotline 

(Output)

FY 2019: 18,468

Target: 18,168

(Target Exceeded)

18,468 18,468 Maintain
90

Tribal Behavioral Health Grants

(Dollars in thousands)

 

Programs of Regional and National Significance

FY 

2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 

2021 

+/-

FY 

2020

Tribal Behavioral Health Grants...................................................... $20,000 $20,000 $20,000 $---

 Authorizing Legislation................................Section 520A of the Public Health Service Act

 FY 2021 Authorization ............................................................................................... $394,550,000

 Allocation Method ......................................Competitive Grants/Contracts Eligible Entities Tribes

Program Description and Accomplishments

Suicide is the second leading cause of death among American Indian/Alaska Native (AI/AN) youth 

ages eight to 24 years.27 Further, AI/AN high school students report higher rates of suicidal 

behaviors than the general population of U.S. high school students.28 These behaviors include 

serious thoughts of suicide, suicide plans, suicide attempts, and medical attention for a suicide 

attempt. However, the risk of suicide is not the same in all AI/AN youth demographic groups. For 

instance, AI/AN youth raised in urban settings have a smaller risk of having thoughts of suicide 

than AI/AN youth raised on tribal reservations (21 percent and 33 percent, respectively).29

Consistent with the goals of the Tribal Behavioral Health Agenda, the Tribal Behavioral Health 

Grant (TBHG) program addresses the high incidence of substance use and suicide among AI/AN 

populations. Starting in FY 2014, this program supports tribal entities with the highest rates of 

suicide by providing effective and promising strategies that address substance abuse, trauma, and 

suicide and by promoting the mental health of AI/AN young people. 

The first cohort of TBHG grants was provided to 20 tribes or tribal organizations with high rates of 

suicide. These five-year grants help grantees develop and implement a plan that addresses suicide 

and substance abuse, thereby promoting mental health among tribal youth. In addition, SAMHSA’s 

Tribal Training and Technical Assistance Center (http://www.samhsa.gov/tribal-ttac) provides 

training and education to AI/AN grantees and organizations serving AI/AN populations to support 

their ability to achieve their goals. 

This initiative takes a comprehensive, culturally appropriate approach to help improve the lives of 

and opportunities for AI/AN youth. In addition to the Department of Health and Human Services, 

multiple agencies, including the Departments of Interior, Education, Housing and Urban 

 27 Centers for Disease Control and Prevention. Fatal injury data, 2010. Web-based Injury Statistics Query and Reporting 

System. Available at www.cdc.gov/injury/wisqars/fatal.html. Accessed May 27, 2014.

28 Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance System (YRBSS). Available at 

http://www.cdc.gov/healthyyouth/yrbs/index.htm. Accessed May 27, 2014. 

29 Freedenthal, S. & Stiffman, A. R. (2004). Suicidal Behavior in Urban American Indian Adolescents: A Comparison 

with Reservation Youth in a Southwestern State. Suicide and Life-Threatening Behavior, 34(2), 160-171.
91

Development, Agriculture, Labor, and Justice, are working collaboratively with tribes to address 

issues facing AI/AN youth. 

In FY 2016, SAMHSA expanded activities through the braided TBHG ($15.0 million in the 

Substance Abuse Prevention appropriation and $15.0 million in Mental Health appropriation) to 

allow tribes the flexibility to implement community-based strategies to address trauma, prevent 

substance abuse, and promote mental health and resiliency among youth in tribal communities. The 

additional FY 2016 funding expanded these activities to approximately 90 tribes and tribal entities. 

With the expansion of the TBHG program, SAMHSA’s goal is to reduce substance use and the 

incidence of suicide attempts among AI/AN youth and to address behavioral health conditions that 

affect learning in the Bureau of Indian Education-funded schools. 

In FY 2018, SAMHSA supported 80 grant continuations, 46 new grants, and technical assistance 

activities. In FY 2019, SAMHSA supported 109 grant continuations, 26 new grants, and technical 

assistance activities. In FY 2020, SAMHSA will fund 121 grant continuations, 14 new grants, and 

technical assistance activities.

Funding History

Fiscal Year Amount

FY 2017 $15,000,000

FY 2018 $15,000,000

FY 2019 $20,000,000

FY 2020 $20,000,000

FY 2021 $20,000,000

Budget Request

The FY 2021 President’s Budget is $20.0 million, level with the FY 2020 Enacted level. This 

request, combined with $20.0 million in the Substance Abuse Prevention will support technical 

assistance activities and 99 continuation grants that promote mental health and prevent substance 

use activities for high-risk AI/AN youth and their families. 

As a braided activity, SAMHSA will track separately any amounts spent or awarded under Tribal 

Behavioral Health Grants through the distinct appropriations and ensure that funds are used for 

purposes consistent with legislative direction and intent of these appropriations.
92

Outputs and Outcomes Table

Program: Tribal Behavioral Health

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

2.4.12 Percentage of youth age 10 -

24 who received mental health or 

related services after screening, 

referral or attempt (Output)

FY 2019: 43

Target: 56

(Target Not Met but Improved)

43 43 Maintain

2.4.13 Number of 

programs/organizations that 

implemented specific mental-health 

related practices/activities as a result 

of the grant (Outcome)

FY 2019: 7,219

Target: 5,670

(Target Exceeded)

7,219 7,219 Maintain
93

Minority Fellowship Program

(Dollars in thousands)

Programs of Regional and National Significance

FY 

2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 

2021 

+/-

FY 

2020

Minority Fellowship Program........................................................... $8,059 $9,059 $9,059 $---

Authorizing Legislation.......................................................Section 597 of the PHS Act

FY 2021 Authorization ................................................................................................... $12,669,000

Allocation Method ...................................................................................................Grants/Contracts

Eligible Entities.......................................Organizations that represent individuals obtaining 

post-baccalaureate training (including for master’s and doctoral degrees) for mental and substance 

use disorder treatment professionals, including in the fields of psychiatry, nursing, social work, 

psychology, marriage and family therapy, mental health counseling, and substance use disorder 

and addiction counseling

Program Description and Accomplishments

SAMHSA’s Minority Fellowship Program (MFP) increases behavioral health practitioners’ 

knowledge of issues related to prevention, treatment, and recovery support for mental illness and 

drug/alcohol addiction among racial and ethnic minority populations. The program provides 

stipends to increase the number of culturally competent behavioral health professionals who teach, 

administer, conduct services research, and provide direct mental illness or substance use disorder 

treatment services for minority populations that are underserved. Since 1973, the program has 

helped to enhance services for racial and ethnic minority communities through specialized training 

of mental health professionals in psychiatry, nursing, social work, and psychology. In 2006, the 

program expanded to include marriage and family therapists and later added professional 

counselors. Professional guilds receive competitively awarded grants, and then competitively 

award the stipends to post-graduate students pursuing a degree in that professional field. The MFP 

program has had a variety of focus including youth and addiction counselors.

In FY 2018, SAMHSA awarded a new cohort of seven MFP grants and a new technical assistance 

contract. In FY 2019, SAMHSA supported seven continuation grants and the technical assistance 

contract. In FY 2020, SAMHSA will fund seven continuation grants, supplemental funds to 

increase the mental health workforce, and the technical assistance contract.
94

 

Funding History

Fiscal Year Amount

FY 2017 $8,059,000 

FY 2018 $8,059,000 

FY 2019 $8,059,000

FY 2020 $9,059,000

FY 2021 $9,059,000

Budget Request

The FY 2021 President’s Budget is $9.0 million, level with FY 2020 Enacted level. SAMHSA 

requests funding to support seven continuation grants and the technical assistance contract.

 
95

Infant and Early Childhood Mental Health

(Dollars in thousands)

 

Programs of Regional and National Significance

FY 

2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 

2021 

+/-

FY 

2020

Infant and Early Childhood Mental Health..................................... $5,000 $7,000 $7,000 $---

Authorization Legislation ..................................... Section 399Z-2 of the Public Health Service Act

FY 2021 Authorization ................................................................................................... $20,000,000

Allocation Method ...............................................................................................Competitive Grants

Eligible Entities.................................Human Services Agencies and Non-profit Institutions

Program Description and Accomplishments

Nearly one in seven US children aged 2 to 8 years has a mental, behavioral, or developmental 

disorder.30 It is also estimated that approximately 9.5 percent–14.2 percent of children birth to 5 

years old experience emotional, relational, or behavioral disturbance.31 Without proper 

intervention, these early childhood disorders can have negative impacts on all areas of a child’s 

development. Young children whose social and emotional development is compromised are at 

higher risk for school problems and juvenile delinquency later in life.32 Rising rates of substanceexposure in infants also require more intensive early childhood services to help improve the 

trajectories of the families where substance misuse is present. 

The authorization for this program was added to the Public Health Service Act by an amendment 

in the 21st Century Cures Act. The first funding for this program was provided in FY 2018. The 

purpose of this program is to improve outcomes for children, from birth to 12 years of age, who are 

at risk for, show early signs of, or have been diagnosed with a mental illness, including a serious 

emotional disturbance. Grantees improve outcomes for children through training early childhood 

providers and clinicians to identify and treat behavioral health disorders of early childhood, 

including in children with a history of in utero exposure to substances such as opioids, stimulants 

 30 Bitsko, RH, Holbrook, JR, Kaminski, J, Robinson, LR, Ghandour, R, Smith, C, Peacock, G. (2016) Health-care, 

Family and Community Factors associated with Mental, Behavioral and Developmental Disorders in Early Childhood 

– United States, 2011-2012. MMWR.; 65(9); 221-226. Available from 

https://www.cdc.gov/ncbddd/childdevelopment/features/key-finding-factors-mental-behavioral-developmental-earlychildhood.html.

31 Brauner, C. B., & Stephens, C. B. (2006). Estimating the prevalence of early childhood serious 

emotional/behavioral disorders: Challenges and recommendations. Public Health Reports, 121(3), 303–310. 

Available from www.ncbi.nlm.nih.gov/pmc/articles/PMC1525276

32 Jones, D. E., Greenberg, M., & Crowley, M. (2015). Early Social-Emotional Functioning and Public Health: The 

Relationship Between Kindergarten Social Competence and Future Wellness. American Journal of Public Health, 

105(11), 2283–2290. http://doi.org/10.2105/AJPH.2015.302630
96

or other drugs that may impact development, and through the implementation of evidence-based 

multigenerational treatment approaches that strengthen caregiving relationships. 

SAMHSA expects this program will increase access to a range of evidence-based and culturallyappropriate infant and early childhood mental health services, and will aid in addressing the national 

shortage of mental health professionals with infant and early childhood expertise.

Because the wellbeing of caregivers dramatically impacts the development of infants and young 

children, this program also promotes a multigenerational approach that supports caregivers and 

other family members of infants and young children. 

In the first year of program funding (FY 2018-2019), grantees:

• Trained more than 1,500 clinicians and early childhood providers on evidence-based 

mental health treatments for infants and young children; 

• Screened and assessed over 2,000 young children for developmental and behavioral 

disorders (including screening parents for behavioral health issues such as depression and 

substance misuse); 

• Referred approximately 900 children and parents for treatment. More than 75% of these 

referrals resulted in successful engagement in treatment; and

• Provided infant and early childhood mental health treatment (including multigenerational 

therapies) to approximately 944 children and families.

In FY 2018, SAMHSA awarded nine new grants for five-years. In FY 2019, SAMHSA supported 

the continuation of nine grants. In FY 2020, SAMHSA anticipates funding nine continuation grants 

and awarding a new cohort of four grants.

Funding History

Fiscal Year Amount

FY 2017 $---

FY 2018 $5,000,000 

FY 2019 $5,000,000

FY 2020 $7,000,000

FY 2021 $7,000,000

Budget Request

The FY 2021 President’s Budget is $7.0 million, level with the FY 2020 Enacted level. SAMHSA 

requests funding to support 13 continuation grants to increase access to a range of evidence-based 

and culturally-appropriate infant and early childhood mental health services. 
97

Outputs and Outcomes Table

Program: Infant and Early Childhood Mental Health

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

3.4.16 Number of children 

screened for mental health or 

related interventions (Output)

FY 2019: 2,000.0

Target: 1,200.0

(Target Exceeded)

2,000.0 2,000.0 Maintain

3.4.17 Number of children referred 

to mental health or related 

interventions (Output)

FY 2019: 931.0

Target: 400.0

(Target Exceeded)

931.0 931.0 Maintain

3.4.18 Number of people in the 

mental health and related 

workforce trained in specific 

mental health-related 

practices/activities as a result of 

the program. (Output)

FY 2019: 1,656.0

Target: 450.0

(Target Exceeded)

1,656.0 1,656.0 Maintain

 
98

Comprehensive Opioid Recovery Centers

(Dollars in thousands)

Programs of Regional and National Significance

FY 

2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 

2021 

+/-

FY 

2020

Comprehensive Opioid Recovery Centers...................................... $0 $2,000 $2,000 $---

Authorizing Legislation ...........Section 7121 of the SUPPORT Act (Section 552 of the PHS Act)

FY 2021 Authorization ....................................................................................................$2,000,000

Allocation Method .............................................................................................Competitive Grants

Eligible Entities. Public and private nonprofit entities (that provide treatment for individuals with 

substance use disorders).

Program Description and Accomplishments

For individuals with opioid use disorders, there is an increasing need for access to coordinated, 

comprehensive care services, including long-term care and support services, that utilize the full 

range of FDA-approved medications and evidence-based treatments.

This program provides grants to nonprofit substance use disorder treatment organizations to operate 

of comprehensive centers which provide a full spectrum of treatment and recovery support services 

for opioid use disorders. The funding represent the first year of a four year project period. Grantees 

are required to provide outreach and the full continuum of treatment services including MAT; 

counseling; treatment for mental disorders; testing for infectious diseases, residential rehabilitation, 

and intensive outpatient programs; recovery housing; peer recovery support services; job training, 

job placement assistance, and continuing education; and family support services such as child care, 

family counseling, and parenting interventions. Grantees must utilize third party and other revenue 

to the extent possible. Grantees will be required to report client-level data, including demographic 

characteristics, substance use, diagnosis, services received, types of MAT received; length of stay 

in treatment; employment status, criminal justice involvement, and housing. 

Funding History

Fiscal Year Amount

FY 2017 ---

FY 2018 ---

FY 2019 ---

 FY 2020 $2,000,000

 FY 2021 $2,000,000
99

Budget Request

The FY 2021 President’s Budget level is $2.0 million, level with the FY 2020 Enacted.

Outputs and Outcomes Table

Program: Comprehensive Opioid Recovery Centers

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020 

Target

FY 2021

Target

FY 2021 

Target

+/-

FY 2020

Target

TBD. Number of people served 

from receiving counseling, 

recovery housing, pharmacy and 

toxicology services, communitybased and peer recovery support 

services (Output)

FY 2020: Result Expected 

December 31, 2021

Target: Set Baseline

(Pending)

Maintain 

Baseline

Maintain 

Baseline

Maintain

TBD. Number of people receiving 

on the job training, job placement 

assistance, and continuing 

education assistance to support, 

and reintegration into the 

workforce. (Output)

FY 2020: Result Expected 

December 31, 2021

Target: Set Baseline

(Pending)

Maintain 

Baseline

Maintain 

Baseline

Maintain

TBD. Number train and supervise 

outreach staff to work with 

healthcare providers to identify 

and respond to community needs. 

(Output) 

FY 2020: Result Expected 

December 31, 2021

Target: Set Baseline

(Pending)

Maintain 

Baseline

Maintain 

Baseline

Maintain
100

SAMHSA/Mental Health

PRNS Mechanism Table Summary

(Dollars in thousands)

Program Activity

FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

No. Amount No. Amount No. Amount

Programs of Regional & National Significance

Grants/Cooperative Agreements

Continuations....................................................................... 684 294,698 766 352,560 588 331,781

193 103,578 165 118,216 320 135,695

Supplements*....................................................................... 24 7,119 --- 20,290 --- 1,897

Subtotal............................................................................... 877 405,395 931 491,066 908 469,373

Contracts

Continuations....................................................................... 7 32,713 6 37,687 5 36,363

New/Competing.................................................................... 9 15,114 1 908 2 4,057

Subtotal............................................................................... 16 47,827 7 38,595 7 40,420

Total, Mental Health PRNS 893 $453,222 938 $529,661 915 $509,793

* Excluding Supplements number count to avoid duplication. 
101

SAMHSA/Mental Health

PRNS Mechanism Table by Program, Project, and Activity

(Dollars in thousands)

FY 2019 Final

FY 2020 

Enacted

FY 2021 

President's 

Budget 

Programs of Regional & National Significance No. Amount No. Amount No. Amount

Capacity:

National Child Traumatic Stress Network

Grants

Continuations................................................................. 100 $50,547 100 $51,028 35 $17,001

New/Competing............................................................. 4 10,000 17 8,400 91 47,931

Supplements*................................................................. --- --- --- 6,000 --- ---

Subtotal........................................................................ 104 60,547 117 65,428 126 64,931

Contracts

Continuations................................................................. --- 3,340 --- 3,459 --- 3,956

New/Competing............................................................. --- --- --- --- --- ---

Subtotal........................................................................ --- 3,340 --- 3,459 --- 3,956

Total ,National Child Traumatic Stress Network 104 63,887 117 68,887 126 68,887

Project AWARE

Grants

Continuations................................................................. 173 74,373 197 85,432 83 85,451

New/Competing............................................................. 24 12,793 32 32,982 136 32,262

Supplements*................................................................. 8 275 --- 275 --- 75

Subtotal........................................................................ 197 87,441 229 118,689 219 117,788

Contracts

Continuations................................................................. --- 4,519 --- 6,275 --- 7,176

New/Competing............................................................. --- 4 --- --- --- ---

Subtotal........................................................................ --- 4,523 --- 6,275 --- 7,176

Total, Project AWARE 197 91,964 229 124,964 219 124,964

Healthy Transitions

Grants

Continuations................................................................. 10 10,498 25 24,921 27 27,487

New/Competing............................................................. 15 14,355 2 2,576 2 1,686

Supplements*................................................................. --- --- --- --- --- ---

Subtotal........................................................................ 25 24,852 27 27,497 29 29,174

Contracts

Continuations................................................................. --- 1,099 --- 1,454 --- 1,777

New/Competing............................................................. --- --- --- --- --- ---

Subtotal........................................................................ --- 1,099 --- 1,454 --- 1,777

Total, Healthy Transitions 25 25,951 27 28,951 29 30,951
102

SAMHSA/Mental Health

PRNS Mechanism Table by Program, Project, and Activity

(Dollars in thousands)

 FY 2019 Final

FY 2020 

Enacted

FY 2021 

President's 

Budget 

Programs of Regional & National Significance No. Amount No. Amount No. Amount

Children and Family Programs

Grants

Continuations................................................................. 14 5,459 1 375 13 5,434

New/Competing............................................................. --- --- 13 5,492 --- ---

Subtotal........................................................................ 14 5,459 14 5,867 13 5,434

Contracts

Continuations................................................................. --- 1,770 --- 1,362 --- 1,795

New/Competing............................................................. --- --- --- --- --- ---

Subtotal........................................................................ --- 1,770 --- 1,362 --- 1,795

Total, Children and Family Programs 14 7,229 14 7,229 13 7,229

Consumer and Family Network Grants

Grants

Continuations................................................................. 25 2,368 49 4,647 26 2,466

New/Competing............................................................. 26 2,468 --- --- 23 2,203

Subtotal........................................................................ 51 4,836 49 4,647 49 4,670

Contracts

Continuations................................................................. --- 118 --- 307 --- 284

New/Competing............................................................. --- --- --- --- --- ---

Subtotal........................................................................ --- 118 --- 307 --- 284

Total, Consumer and Family Network Grants 51 4,954 49 4,954 49 4,954

Project LAUNCH

Grants

Continuations................................................................. 14 8,789 31 22,420 31 22,218

New/Competing............................................................. 17 13,565 --- --- --- ---

Supplements*................................................................. --- --- --- --- --- ---

Subtotal........................................................................ 31 22,355 31 22,420 31 22,218

Contracts

Continuations................................................................. --- 1,250 --- 1,185 --- 1,356

New/Competing............................................................. --- --- --- --- --- 31

Subtotal........................................................................ --- 1,250 --- 1,185 --- 1,387

Total, Project LAUNCH 31 23,605 31 23,605 31 23,605

Mental Health System Transformation and Health Reform

Grants

Continuations................................................................. --- --- 3 3,589 3 2,941

New/Competing............................................................. 3 2,687 --- --- --- ---

Supplements*................................................................. --- --- --- --- --- ---

Subtotal........................................................................ 3 2,687 3 3,589 3 2,941

Contracts

Continuations................................................................. --- 1,092 --- 190 --- 838

New/Competing............................................................. --- --- --- --- --- ---

Subtotal........................................................................ --- 1,092 --- 190 --- 838

Total, Mental Health System Transformation and 

Health Reform 3 3,779 3 3,779 3 3,779
103

 SAMHSA/Mental Health

PRNS Mechanism Table by Program, Project, and Activity

(Dollars in thousands)

FY 2019 Final

FY 2020 

Enacted

FY 2021 

President's 

Budget 

Programs of Regional & National Significance No. Amount No. Amount No. Amount

Primary and Behavioral Health Care Integration

Grants

Continuations................................................................. 28 29,513 20 39,686 --- ---

New/Competing............................................................. --- --- 4 7,687 --- ---

Supplements*................................................................. --- --- --- --- --- ---

Subtotal........................................................................ 28 29,513 24 47,372 --- ---

Contracts

Continuations................................................................. --- 2,043 --- 2,505 --- ---

New/Competing............................................................. 6 11,881 --- --- --- ---

Subtotal........................................................................ 6 13,924 --- 2,505 --- ---

Total, PBHCI 34 43,438 24 49,877 --- ---

National Strategy for Suicide Prevention

Grants

Continuations................................................................. 20 10,150 15 7,792 34 16,836

New/Competing............................................................. --- --- 19 9,044 4 2,696

Supplements*................................................................. --- 450 --- 450 --- 450

Subtotal........................................................................ 20 10,600 34 17,286 38 19,983

Contracts

Continuations................................................................. --- 596 --- 914 --- 1,217

New/Competing............................................................. --- 4 --- --- --- ---

Subtotal........................................................................ --- 600 --- 914 --- 1,217

Total, National Strategy for Suicide Prevention 20 11,200 34 18,200 38 21,200

GLS - Youth Suicide Prevention - States

Grants

Continuations................................................................. 19 12,328 38 26,459 44 31,189

New/Competing............................................................. 31 21,397 10 6,989 3 2,214

Subtotal........................................................................ 50 33,725 48 33,448 47 33,403

Contracts

Continuations................................................................. --- 1,697 --- 1,979 --- 2,024

New/Competing............................................................. --- 5 --- --- --- ---

Subtotal........................................................................ --- 1,702 --- 1,979 --- 2,024

Total, GLS - States 50 35,427 48 35,427 47 35,427

GLS - Youth Suicide Prevention - Campus

Grants

Continuations................................................................. 41 3,946 46 4,526 38 3,739

New/Competing............................................................. 22 2,206 16 1,498 22 2,302

Subtotal........................................................................ 63 6,152 62 6,024 60 6,040

Contracts

Continuations................................................................. --- 332 --- 464 --- 448

New/Competing............................................................. --- 4 --- --- --- ---

Subtotal........................................................................ --- 336 --- 464 --- 448

Total, GLS - Campus 63 6,488 62 6,488 60 6,488
104

SAMHSA/Mental Health

PRNS Mechanism Table by Program, Project, and Activity

(Dollars in thousands)

FY 2019 Final

FY 2020 

Enacted

FY 2021 

President's 

Budget 

Programs of Regional & National Significance No. Amount No. Amount No. Amount

GLS - Suicide Prevention Resource Center

Grants

Continuations................................................................. 1 5,634 --- --- 1 7,529

New/Competing............................................................. --- --- 1 7,587 --- ---

Subtotal........................................................................ 1 5,634 1 7,587 1 7,529

Contracts

Continuations................................................................. --- 354 --- 401 --- 459

New/Competing............................................................. --- --- --- --- --- ---

Subtotal........................................................................ --- 354 --- 401 --- 459

Total, GLS - Suicide Prevention Resource Center 1 5,988 1 7,988 1 7,988

Suicide Lifeline

Grants

Continuations................................................................. 1 5,302 3 5,969 2 667

New/Competing............................................................. 2 664 --- --- 1 17,242

Supplements*................................................................. 1 5,414 --- 12,077 --- ---

Subtotal........................................................................ 3 11,379 3 18,046 3 17,909

Contracts

Continuations................................................................. --- 621 --- 954 --- 1,091

New/Competing............................................................. --- --- --- --- --- ---

Subtotal........................................................................ --- 621 --- 954 --- 1,091

Total, Suicide Lifeline 3 12,000 3 19,000 3 19,000

AI/AN Suicide Prevention Initiative

Grants

Continuations................................................................. 1 500 1 500 1 500

New/Competing............................................................. --- --- --- --- --- ---

Subtotal........................................................................ 1 500 1 500 1 500

Contracts

Continuations................................................................. 1 2,431 1 2,431 --- 168

New/Competing............................................................. --- --- --- --- 1 2,263

Subtotal........................................................................ 1 2,431 1 2,431 1 2,431

Total, AI/AN 2 2,931 2 2,931 2 2,931

Homelessness Prevention Programs

Grants

Continuations................................................................. 40 17,090 43 23,572 48 26,836

New/Competing............................................................. 19 10,316 5 3,500 --- ---

Supplements*................................................................. --- 80 --- --- --- ---

Subtotal........................................................................ 59 27,486 48 27,071 48 26,836

Contracts

Continuations................................................................. --- 1,159 1 3,625 1 3,860

New/Competing............................................................. 1 2,051 --- --- --- ---

Subtotal........................................................................ 1 3,210 1 3,625 1 3,860

Total, Homelessness Prevention Programs 60 30,696 49 30,696 49 30,696
105

SAMHSA/Mental Health

PRNS Mechanism Table by Program, Project, and Activity

(Dollars in thousands)

FY 2019 Final

FY 2020 

Enacted

FY 2021 

President's 

Budget 

Programs of Regional & National Significance No. Amount No. Amount No. Amount

Comprehensive Opioid Recovery Centers

Grants

Continuations................................................................. --- --- --- --- --- 1,885

New/Competing............................................................. --- --- --- 1,900 --- ---

Subtotal........................................................................ --- --- --- 1,900 --- 1,885

Contracts

Continuations................................................................. --- --- --- 100 --- ---

New/Competing............................................................. --- --- --- --- --- 115

Subtotal........................................................................ --- --- --- 100 --- 115

Total, Comprehensive Opioid Recovery Centers --- --- --- 2,000 --- 2,000

Minority AIDS

Grants

Continuations................................................................. 18 8,683 18 8,754 18 8,694

New/Competing............................................................. --- --- --- --- --- ---

Subtotal........................................................................ 18 8,683 18 8,754 18 8,694

Contracts

Continuations................................................................. --- 541 --- 470 --- 530

New/Competing............................................................. --- --- --- --- --- ---

Subtotal........................................................................ --- 541 --- 470 --- 530

Total, Minority AIDS 18 9,224 18 9,224 18 9,224

Criminal and Juvenile Justice Programs

Grants

Continuations................................................................. 11 3,448 11 3,543 17 5,437

New/Competing............................................................. --- --- 6 1,903 8 2,683

Subtotal........................................................................ 11 3,448 17 5,446 25 8,120

Contracts

Continuations................................................................. 1 821 1 823 1 1,149

New/Competing............................................................. --- --- --- --- --- ---

Subtotal........................................................................ 1 821 1 823 1 1,149

Total, Criminal and Juvenile Justice Programs 12 4,269 18 6,269 26 9,269

Seclusion and Restraint

Grants

Continuations................................................................. 11 1,087 11 1,089 11 1,080

New/Competing............................................................. --- --- --- --- --- ---

Subtotal........................................................................ 11 1,087 11 1,089 11 1,080

Contracts

Continuations................................................................. --- 60 --- 58 --- 67

New/Competing............................................................. --- --- --- --- --- ---

Subtotal........................................................................ --- 60 --- 58 --- 67

Total, Seclusion and Restraint 11 1,147 11 1,147 11 1,147
106

SAMHSA/Mental Health

PRNS Mechanism Table by Program, Project, and Activity

(Dollars in thousands)

 FY 2019 Final

 FY 2020 

Enacted

FY 2021 

President's 

Budget 

Programs of Regional & National Significance No. Amount No. Amount No. Amount

Assertive Community Treatment for Individuals with SMI

Grants

Continuations................................................................. 7 4,733 7 4,740 9 6,652

New/Competing............................................................. --- --- 2 1,909 24 16,912

Subtotal........................................................................ 7 4,733 9 6,648 33 23,564

Contracts

Continuations................................................................. --- 267 --- 352 --- 1,436

New/Competing............................................................. --- --- --- --- --- ---

Subtotal........................................................................ --- 267 --- 352 --- 1,436

Total, Assertive Community Treatment for Individuals 

with Serious Mental Illness 7 5,000 9 7,000 33 25,000

Assisted Outpatient Treatment for Individuals with SMI

Grants

Continuations................................................................. 19 13,515 4 2,849 18 17,563

New/Competing............................................................. --- --- 15 15,403 6 6,527

Supplements*................................................................. 15 450 --- 100 --- 75

Subtotal........................................................................ 19 13,965 19 18,353 24 24,165

Contracts

Continuations................................................................. --- 1,035 --- 491 --- 835

New/Competing............................................................. --- --- --- 156 --- ---

Subtotal........................................................................ --- 1,035 --- 647 --- 835

Total, AOT for Individuals with SMI 19 15,000 19 19,000 24 25,000

Tribal Behavioral Health Grants

Grants

Continuations................................................................. 109 8,971 121 10,176 99 17,094

New/Competing............................................................. 26 8,228 14 7,257 --- ---

Subtotal........................................................................ 135 17,199 135 17,433 99 17,094

Contracts

Continuations................................................................. 1 2,793 1 2,567 --- 1,258

New/Competing............................................................. --- 8 --- --- 1 1,648

Subtotal........................................................................ 1 2,801 1 2,567 1 2,906

Total, Tribal Behavioral Health Grants 136 20,000 136 20,000 100 20,000

Infant and Early Childhood Mental Health

Grants

Continuations................................................................. 9 4,299 9 4,431 13 6,595

New/Competing............................................................. --- --- 4 2,217 --- ---

Subtotal........................................................................ 9 4,299 13 6,648 13 6,595

Contracts

Continuations................................................................. --- 701 --- 352 --- 405

New/Competing............................................................. --- --- --- --- --- ---

Subtotal........................................................................ --- 701 --- 352 --- 405

Total, Infant and Early Childhood Mental Health 9 5,000 13 7,000 13 7,000

Subtotal, Capacity 870 $429,177 917 $504,616 895 $486,739
107

SAMHSA/Mental Health

PRNS Mechanism Table by Program, Project, and Activity

(Dollars in thousands)

 FY 2019 Final

 FY 2020 

Enacted

FY 2021 

President's 

Budget 

Programs of Regional & National Significance No. Amount No. Amount No. Amount

Science and Service:

Primary and Behavioral Health Care Integration TA

Grants

Continuations................................................................. --- --- 1 1,889 --- ---

New/Competing............................................................. --- 1,889 --- --- --- ---

Supplements*................................................................. --- --- --- --- --- ---

Subtotal........................................................................ --- 1,889 1 1,889 --- ---

Contracts

Continuations................................................................. --- 102 --- 102 --- ---

New/Competing............................................................. --- --- --- --- --- ---

Subtotal........................................................................ --- 102 --- 102 --- ---

Total, PBHCI TA --- 1,991 1 1,991 --- ---

Practice Improvement & Training

Grants

Continuations................................................................. 1 2,643 5 5,084 5 6,485

New/Competing............................................................. 4 2,864 --- 50 --- ---

Supplements*................................................................. --- 450 --- --- --- ---

Subtotal........................................................................ 5 5,957 5 5,134 5 6,485

Contracts

Continuations................................................................. 2 1,653 1 2,694 1 1,343

New/Competing............................................................. 1 217 --- --- --- ---

Subtotal........................................................................ 3 1,871 1 2,694 1 1,343

Total, Practice Improvement & Training 8 7,828 6 7,828 6 7,828

Consumer and Consumer-Supporter TA Centers

Grants

Continuations................................................................. 5 1,804 --- --- 5 1,808

New/Competing............................................................. --- --- 5 1,822 --- ---

Subtotal........................................................................ 5 1,804 5 1,822 5 1,808

Contracts

Continuations................................................................. --- 114 --- 96 --- 110

New/Competing............................................................. --- --- --- --- --- ---

Subtotal........................................................................ --- 114 --- 96 --- 110

Total, CCSTAC 5 1,918 5 1,918 5 1,918
108

SAMHSA/Mental Health

PRNS Mechanism Table by Program, Project, and Activity

(Dollars in thousands)

FY 2019 Final

FY 2020 

Enacted

FY 2021 

President's 

Budget 

Programs of Regional & National Significance No. Amount No. Amount No. Amount

Disaster Response

Grants

Continuations................................................................. --- 828 --- 828 --- ---

New/Competing............................................................. --- --- --- --- --- 1,037

Subtotal........................................................................ --- 828 --- 828 --- 1,037

Contracts

Continuations................................................................. --- 185 1 1,125 1 916

New/Competing............................................................. 1 940 --- --- --- ---

Subtotal........................................................................ 1 1,125 1 1,125 1 916

Total, Disaster Response 1 1,953 1 1,953 1 1,953

Homelessness

Grants

Continuations................................................................. --- 1,356 --- 1,428 --- 1,361

New/Competing............................................................. --- 146 --- --- --- ---

Subtotal........................................................................ --- 1,502 --- 1,428 --- 1,361

Contracts

Continuations................................................................. 1 794 --- 115 1 935

New/Competing............................................................. --- --- 1 752 --- ---

Subtotal........................................................................ 1 794 1 868 1 935

Total, Homelessness 1 2,296 1 2,296 1 2,296

Minority Fellowship Program

Grants

Continuations................................................................. 7 6,833 7 6,833 7 6,833

New/Competing............................................................. --- --- --- --- --- ---

Supplements*................................................................. --- --- --- 1,388 --- 1,297

Subtotal........................................................................ 7 6,833 7 8,221 7 8,130

Contracts

Continuations................................................................. 1 1,226 --- 838 --- 929

New/Competing............................................................. --- --- --- --- --- ---

Subtotal........................................................................ 1 1,226 --- 838 --- 929

Total, Minority Fellowship Program 8 8,059 7 9,059 7 9,059

Subtotal, Science and Service 23 24,045 21 25,045 20 23,054

Total, Mental Health PRNS 893 $453,222 938 $529,661 915 $509,793

* Excluding Supplements number count to avoid duplication. 
109

 Grant Awards Table

(Whole dollars)

 FY 2019 

Final 

FY 2020 

Enacted 

FY 2021 

President's Budget 

Number of 

Awards 877 931 908

Average Awards $462,252 $527,461 $516,930

Range of Awards $15,000 - $6,000,000 $15,000 - $6,000,000 $15,000 - $6,000,000
110

Children’s Mental Health Services

(Dollars in thousands)

Program

FY 2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 2020

Children's Mental Health Services..................................... $125,000 $125,000 $125,000 $---

Authorizing Legislation .............................................Sections 561 of the Public Health Service Act

FY 2021 Authorization ................................................................................................. $119,026,000

Allocation Method ..............................................................................Competitive Grants/Contracts

Eligible Entities.................................................States, Tribes, Communities, Territories

Program Description and Accomplishments

It is estimated that over 7.4 million children and youth in the United States have a serious mental 

disorder. Unfortunately, only 41 percent of those in need of mental health services actually receive 

treatment.33 Created in 1992, SAMHSA's Children's Mental Health Initiative (CMHI) addresses 

this gap by supporting "systems of care" (SOC) for children and youth with serious emotional 

disturbances and their families to increase their access to evidence-based treatment and supports. 

The 21st Century Cures Act reauthorized the CMHI through FY 2022. Approximately 9-13 percent 

of America’s youth are estimated to have a serious emotional disturbance (SED), the term 

analogous to serious mental illness when applied to children. CMHI provides grants to assist states, 

local governments, tribes, and territories in their efforts to deliver services and supports to meet the 

needs of children and youth with SED. 

CMHI supports the development, implementation, expansion, and sustainability of comprehensive, 

community-based services that use the SOC approach. SOC is a strategic approach to the delivery 

of services and supports that incorporates family-driven, youth-guided, strength-based, and 

culturally and linguistically competent care in order to meet the physical, intellectual, emotional, 

cultural, and social needs of children and youth throughout the U.S. The SOC approach helps 

prepare children and youth for successful transition to adulthood and assumption of adult roles and

responsibilities. Services are delivered in the least restrictive environment with evidence-supported 

treatments and interventions. Individualized care management ensures that planned services and 

supports are delivered with an appropriate, effective, family-driven, and youth-guided approach. 

This approach has demonstrated improved outcomes for children at home, at school, and in their 

communities. For example, CMHI grantee data show that suicide attempt rates significantly 

decreased within 12 months after children and youth accessed CMHI-related SOC services. The 

proportion of children and youth who received good grades (defined as an average grade of C or 

better on the previous report card) significantly increased after 12 months of services, and arrest 

rates significantly decreased after 12 months of children and youth beginning SOC-related services 

and supports.34

 33 Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, 2016 

National Survey on Drug Use and Health. 

34 U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, 

(2016). The Comprehensive Community Mental Health Services for Children with Serious Emotional Disturbances 

Program, Report to Congress 2016. https://store.samhsa.gov/shin/content//PEP18-CMHI2016/PEP18-CMHI2016.pdf.
111

In addition, the CMHI program seeks to address behavioral health disparities for children and youth 

with SED/Serious Mental Illness (SMI) from racial and ethnic minorities by promoting clear and 

culturally competent strategies to improve their access, use of services, and outcomes.

SAMHSA funding ensures that grantees will continue to expand and sustain CMHI SOC values, 

principles, infrastructure, and services throughout their states, tribes, and territories. A central focus 

of these efforts is ensuring collaboration between the CMHI SOC and other child-and 

youth- serving systems (e.g., Child Welfare, Juvenile Justice, and Education). SAMHSA also 

strongly encourages efforts by CMHI SOC grantees to coordinate with other SAMHSA programs, 

such as those supported by the Community Mental Health Services Block Grant (MHBG) and 

Substance Abuse Prevention and Treatment Block Grant (SABG).

CMHI is in the final year of the national evaluation contract for the 2015 cohort, which is designed 

to provide information on: 1) the mental health outcomes of children and youth, and their families; 

2) the implementation, process, and sustainability of SOC; and 3) critical and emerging issues in 

children’s and youth’s mental health. The evaluation includes an SOC assessment that describes 

the infrastructure and an assessment of outcomes derived from direct SOC services. A service 

experience study evaluates: 1) change in service use patterns of children and their families; 2) 

differences in client satisfaction between groups of children (and their families) in the SOC 

communities who receive an evidence- based treatment and those who do not; and 3) retention in 

services.

The Annual Report to Congress for this program provides national data indicating that CMHI SOCs 

are successful and result in many favorable outcomes for children, youth, and their families, 

including: 

• 62.7 percent increase in everyday functioning from intake to follow-up; 

• 17.5 percent improvement in psychological distress; 

• 9.3 increase in school attendance and achievement; 

• 10.4 percent increase in community retention: and

• 16.5 percent increase in social connectedness.

In FY 2018, SAMHSA supported 62 continuation grants, 6 new grants, and 2 contracts. In 

FY 2019, SAMHSA supported 49 continuation grants, 28 new grants, and 2 contracts. In FY 2020, 

SAMHSA will support 45 continuation grants and award a new cohort of 21 grants, and a new 

technical assistance center.

Set-aside for Early Intervention Demonstration Program for Youth and Young Adults at Clinical 

High Risk for Psychosis

In FY 2018, SAMHSA implemented the Community Programs for Outreach with Youth and Young 

Adults at Clinical High Risk for Psychosis (CHR-P) often referred to as the “prodrome phase;” 

which is when a disease process has begun but is not yet diagnosable or inevitable. SAMHSA 

awarded 21 grants funded from a 10 percent set-aside of the base program (CMHI). 
112

This program will address whether community-based intervention during this phase can prevent the 

development of psychosis. Grantees will focus on youth and young adults who are identified to be 

at clinical high risk for developing a fist episode of psychosis. Grantees will focus on this 

population in order to support the development and implementation of evidence-based programs 

providing community outreach and psychosocial interventions for youth and young adults in the 

prodrome phase of psychotic illness.

In FY 2019, SAMHSA funded 21 continuation grants funded from the 10 percent set-aside. In 

FY 2020, SAMHSA anticipates funding 21 continuation grants and a new cohort of nine grants.

Funding History

Fiscal Year Amount

FY 2017 $119,026,000

FY 2018 $125,000,000

FY 2019 $125,000,000

FY 2020 $125,000,000

FY 2021 $125,000,000

Budget Request

The FY 2021 President’s Budget is $125.0 million, level with the FY 2020 Enacted. The budget 

request will support the continuation of 30 demonstration grants under the 10 percent set-aside. In 

addition, funding will also support 55 continuation grants, a new cohort of 15 SOC grants, and the 

continuation of the technical assistance center. This funding will provide training to over 103,858 

people in the mental health and related workforce and serve over 13,483 children with serious 

emotional disturbances. 
113

Outputs and Outcomes Table

Program: Children's Mental Health Initiative 

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

3.2.16 Number of children with severe 

emotional disturbance that are receiving 

services from the Children's Mental 

Health Initiative (Output)

FY 2019: 12,690

Target: 13,483

(Target Not Met)

12,690 12,690 Maintain

3.2.25 Percentage of children receiving 

services who report positive social 

support at 6 month follow-up (Outcome)

FY 2019: 87.1 %

Target: 87.7 %

(Target Not Met)

87.1 % 87.1 % Maintain

3.2.26 Percentage of children receiving 

Systems of Care mental health services 

who report positive functioning at 6 

month follow-up (Outcome)

FY 2019: 65.0 %

Target: 62.9 %

(Target Exceeded)

65.0 % 65.0 % Maintain

3.2.27 Number of people in the mental 

health and related workforce trained in 

specific mental health-related 

practices/activities as a result of the 

program (Output)

FY 2019: 71,968

Target: 103,858

(Target Not Met)

71,968 71,968 Maintain
114

SAMHSA/Mental Health

Children’s Mental Health Services

Mechanism Table 

(Dollars in thousands)

Program Activity

FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

No. Amount No. Amount No. Amount

Children's Mental Health Services

Grants/Cooperative Agreements

Continuations....................................................................... 62 $77,408 66 $79,003 86 $92,774

New/Competing.................................................................... 28 39,611 31 39,645 15 24,973

Subtotal............................................................................... 90 117,019 97 118,648 101 117,747

Contracts

Continuations....................................................................... --- 293 --- 6,352 --- 7,253

New/Competing.................................................................... --- --- --- --- --- ---

Subtotal............................................................................... --- 293 --- 6,352 --- 7,253

Technical Assistance............................................................. 1 7,688 --- --- --- ---

Total, Children's Mental Health Services 91 $125,000 97 $125,000 101 $125,000

* Totals may not add due to rounding.
115

Grant Awards Table

(Whole dollars)

FY 2019 

Final 

FY 2020 

Enacted 

FY 2021 

President's Budget 

Number of 

Awards 90 97 101

Average Awards $1,300,211 $1,223,176 $1,165,810

Range of Awards $330,000 - $2,000,000 $330,000 - $2,000,000 $330,000 - $2,000,000
116

 Projects for Assistance in Transition from Homelessness

(Dollars in thousands)

Program

FY 2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 2020

PATH............................................................................ $64,635 $64,635 $64,635 $---

Authorizing Legislation ..........................................Section 535(a) of the Public Health Service Act

FY 2021 Authorization ................................................................................................... $64,635,000

Allocation Method .....................................................................................................Formula Grants

Eligible Entities.................................................................................................States and Territories

Program Description and Accomplishments

In 2018, an estimated 553,742 individuals experienced homelessness on an average night.35 Data 

suggest that approximately 20 percent of individuals experiencing homelessness have a serious 

mental illness (SMI),36 Mental illness affects individuals’ abilities to maintain stable relationships, 

perform daily living activities, and maintain stable employment. Symptoms of mental disorders 

also often cause individuals to become estranged from family members and caregivers, leaving 

them without a support system. As a result, individuals with a mental illness are more likely to 

experience homelessness than those without mental illness and experience homelessness longer 

than the rest of the homeless population.

PATH program’s efforts to identify primary care, behavioral disorder treatment, and housing for 

individuals who experience chronic homelessness is two to three times more cost effective than 

having them in the criminal justice system or treating them via other costly healthcare settings (e.g., 

emergency rooms, critical care units).

In 1990, the Stewart B. McKinney Homeless Assistance Amendments Act authorized the PATH 

program to provide services to individuals who are experiencing homelessness and SMI. The 

PATH program supports 56 grants to the 50 states, the District of Columbia, Puerto Rico, Guam, 

American Samoa, the United States Virgin Islands, and the Northern Mariana Islands, as well as 

centralized activities such as technical assistance and evaluation. PATH was reauthorized by the 

21st Century Cures Act in December 2016. PATH funds community-based outreach, mental illness 

and substance abuse treatment services, case management, assistance with accessing housing, and 

other supportive services. PATH helps to engage people with SMI into mental disorder treatment 

as well as persons with SMI with a co-occurring substance use disorder. PATH outreach workers 

are specialized in engaging those who are most vulnerable in their communities and who are least 

likely to seek out services on their own. PATH’s primary goal is to bring the most vulnerable into 

 35 The U.S. Department of Housing and Urban Development, Office of Community Planning and Development. 

(2018). The 2018 Annual Homeless Assessment Report (AHAR) to Congress, Part 1. Available 

at: https://www.files.hudexchange.info/resources/documents/2018-AHAR-Part-1.pdf 36 The U.S. Department of Housing and Urban Development, 2018 CoC Homeless Populations and Subpopulations 

Reports. Available at 

https://www.hudexchange.info/resource/reportmanagement/published/CoC_PopSub_NatlTerrDC_2018.pdf
117

the service system and to connect them with the mainstream resources and supportive services that 

they need in order to access and sustain stable housing, build social connections, and access 

treatment and services to support their recovery. 

Government wide efforts to target the most vulnerable, including people experiencing chronic 

homelessness and veterans, may have served to reduce the number of people on the streets. In 

2010, 106,107 of the people identified in the Point in Time (PIT) survey administered annually by 

the U.S. Department of Housing and Urban Development (HUD) were experiencing chronic 

homelessness. By 2018, this number had declined to 96,913. At its lowest, in 2016, the number of 

people experiencing chronic homelessness was 86,132. The number was up to 95,419 in 2017 and 

up again to 96,913 in 2018. Veterans were first tracked in the 2011 Continuum of Care Homeless 

Assistance Programs report on homeless populations and subpopulations. That year, 65,455 

veterans were identified during the PIT. By 2018, that number had dropped to 37,878 or by 42 

percent. This may be attributed to the additional resources created at the federal level to address 

veteran homelessness. 

These efforts may also have reduced the number of PATH–eligible people on the streets. In 

FY 2018, PATH program staff contacted 147,952 persons experiencing homelessness; of those 

70,792 (47.8%) were actively enrolled in PATH at some point during the reporting period.

Of the 70,792 people who were actively enrolled in PATH in 2018, 40.9 percent (28,945) were 

experiencing co-occurring drug/alcohol use disorders. Of those enrolled in PATH, 46,230 were 

receiving community mental health services, 6,723 received substance abuse treatment and 9,317 

received referrals to substance abuse treatment services in the community. PATH provided housing 

moving assistance to 2,854 individuals, housing eligibility determination services to 16,218 

individuals and one-time rent eviction to 1,207 individuals. In addition, 17,246 PATH clients were 

referred to permanent housing and of those, 8,623 were able to attain permanent housing. Of the 

8,664 PATH clients who were referred to temporary housing, 5,393 attained the temporary housing. 

Services provided by the PATH program fill gaps in existing community resources and play a 

crucial role in communities’ strategic plans to end homelessness.
118

Funding History

Fiscal Year Amount

FY 2017 $64,635,000

FY 2018 $64,635,000

FY 2019 $64,635,000

FY 2020 $64,635,000

FY 2021 $64,635,000

Budget Request

The FY 2021 President’s Budget is $64.6 million, level with the FY 2020 Enacted. This 

formula- based funding to states will continue PATH services in over 500 communities that the 

states provide funding to in order to support outreach workers and mental health specialists that 

engage with individuals who are living with SMI or those living with both SMI and drug/alcohol 

addiction and are homeless or at imminent risk of becoming homeless. The services provided by 

the program help ensure that these individuals have an opportunity to access stable housing, 

improve their health and wellness, lead self-directed lives, and achieve their full potential. 
119

Outputs and Outcomes Table

Program: Projects for Assistance in Transition from Homelessness

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

3.4.15 Percentage of enrolled 

homeless persons in the Projects for 

Assistance in Transition from 

Homelessness (PATH) program who 

receive community mental health 

services (Intermediate Outcome)

FY 2018: 65 %

Target: 54 %

(Target Exceeded)

65 % 65 % Maintain

3.4.16 Number of homeless persons 

contacted (Outcome)

FY 2018: 121,561

Target: 174,978

(Target Not Met but Improved)

120,048 120,048 Maintain

3.4.17 Percentage of contacted 

homeless persons with serious mental 

illness who become enrolled in 

services (Outcome)

FY 2018: 58 %

Target: 57 %

(Target Exceeded)

58 % 58 % Maintain

3.4.20 Number of Projects for 

Assistance in Transition from 

Homelessness (PATH) providers 

trained on SSI/SSDI Outreach, 

Access, Recovery (SOAR) to ensure 

eligible homeless clients are receiving 

benefits (Output)

FY 2019: 2,214

Target: 2,647

(Target Not Met)

2,214 2,214 Maintain
120

 Department of Health and Human Services

Substance Abuse and Mental Health Services Administration

FY 2021 PATH Formula Grant Final Allotments

Appropriation Amount $64,635,000, State-Territory Total $61,338,872

CFDA # 93.150

State/Territory

FY 2019

Final

FY 2020

Enacted

FY 2021

President's 

Budget

FY 2021

+/-

FY 2020

Alabama $613,144 $613,087 $610,239 -$2,848

Alaska 300,000 300,000 300,000 ---

Arizona 1,349,474 1,349,348 1,343,081 -6,267

Arkansas 303,984 303,956 302,544 -1,412

California 8,814,326 8,813,505 8,772,565 -40,940

Colorado 1,019,261 1,019,165 1,014,432 -4,733

Connecticut 799,483 799,408 795,695 -3,713

Delaware 300,000 300,000 300,000 ---

District of Columbia 300,000 300,000 300,000 ---

Florida 4,334,938 4,334,533 4,314,401 -20,132

Georgia 1,670,242 1,670,086 1,662,329 -7,757

Hawaii 300,000 300,000 300,000 ---

Idaho 300,000 300,000 300,000 ---

Illinois 2,705,569 2,705,316 2,692,751 -12,565

Indiana 1,011,644 1,011,549 1,006,851 -4,698

Iowa 334,605 334,573 333,020 -1,553

Kansas 377,443 377,407 375,655 -1,752

Kentucky 468,968 468,924 466,747 -2,177

Louisiana 733,147 733,078 729,674 -3,404

Maine 300,000 300,000 300,000 ---

Maryland 1,271,711 1,271,592 1,265,686 -5,906

Massachusetts 1,559,081 1,558,935 1,551,695 -7,240

Michigan 1,729,806 1,729,644 1,721,611 -8,033

Minnesota 811,099 811,023 807,256 -3,767

Mississippi 300,000 300,000 300,000 ---

Missouri 893,903 893,819 889,668 -4,151

Montana 300,000 300,000 300,000 ---

Nebraska 300,000 300,000 300,000 ---

Nevada 616,023 615,965 613,104 -2,861

New Hampshire 300,000 300,000 300,000 ---

 
121

Department of Health and Human Services

Substance Abuse and Mental Health Services Administration

FY 2021 PATH Formula Grant Final Allotments

Appropriation Amount $64,635,000, State-Territory Total $61,338,872

CFDA # 93.150

State/Territory

FY 2019

Final

FY 2020

Enacted

FY 2021

President's 

Budget

FY 2021

+/-

FY 2020

New Jersey 2,138,448 2,138,248 2,128,317 -9,931

New Mexico 300,000 300,000 300,000 ---

New York 4,223,719 4,223,324 4,203,708 -19,616

North Carolina 1,379,802 1,379,673 1,373,265 -6,408

North Dakota 300,000 300,000 300,000 ---

Ohio 1,986,772 1,986,586 1,977,359 -9,227

Oklahoma 452,895 452,853 450,750 -2,103

Oregon 631,098 631,039 628,108 -2,931

Pennsylvania 2,367,227 2,367,006 2,356,013 -10,993

Rhode Island 300,000 300,000 300,000 ---

South Carolina 680,315 680,251 677,092 -3,159

South Dakota 300,000 300,000 300,000 ---

Tennessee 909,896 909,811 905,586 -4,225

Texas 4,996,262 4,995,795 4,972,591 -23,204

Utah 591,558 591,503 588,756 -2,747

Vermont 300,000 300,000 300,000 ---

Virginia 1,472,418 1,472,281 1,465,443 -6,838

Washington 1,329,353 1,329,229 1,323,055 -6,174

West Virginia 300,000 300,000 300,000 ---

Wisconsin 836,768 836,690 832,804 -3,886

Wyoming 300,000 300,000 300,000 ---

Puerto Rico 891,244 891,161 887,021 -4,140

Guam 50,000 50,000 50,000 ---

Virgin Islands 50,000 50,000 50,000 ---

American Samoa 50,000 50,000 50,000 ---

Northern Mariana 

Islands 50,000 50,000 50,000 ---
122

Protection and Advocacy for Individuals with Mental Illness (PAIMI)

(Dollars in thousands)

Program

FY 2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 2020

PAIMI.................................................................... $36,146 $36,146 $14,146 -$22,000

Authorizing Legislation..........................................The PAIMI Act, 42 U.S.C. 10801 et seq.

FY 2021 Authorization ................................................................................................... $19,500,000

Allocation Method .....................................................................................................Formula Grants

Eligible Entities........................................................................States and Territories

Program Description and Accomplishments

The Protection and Advocacy for Individuals with Mental Illness (PAIMI) program ensures that 

the most vulnerable individuals with serious mental illness, especially those residing in public and 

private residential care and treatment facilities, are free from abuse, including inappropriate 

restraint and seclusion, neglect, and rights violations while receiving appropriate mental disorder 

treatment and discharge planning services. 

The Protection and Advocacy for Individuals with Mental Illness Act of 1986, as amended by the 

Children’s Health Act of 2000, extended the protections of the Developmental Disabilities (DD) 

Assistance Act of 1975 to individuals with significant mental illness (adults) and significant 

emotional impairments (children/youth) at risk for abuse, neglect, and rights violations while 

residing in public and private care treatment facilities. The PAIMI Act authorized the same 

governor-designated state protection and advocacy (P&A) systems established under the DD Act 

of 1975 to receive PAIMI Program formula grant awards from SAMHSA. The PAIMI Program 

supports legal-based advocacy services that are provided by the 57 governor-designated P&A 

systems, which include states, territories, and the District of Columbia. Each system is mandated 

to: 1) ensure that the rights of individuals with mental illness who are at risk for abuse, neglect, 

and rights violations while residing in public or private care or treatment facilities are protected; 2) 

protect and advocate for the rights of these individuals through activities that ensure the 

enforcement of the Constitution and federal and state statutes; and 3) investigate incidents of abuse 

and/or neglect of individuals with mental illness. 

In FY 2018, the 57 state PAIMI Programs:

• Served 9,507 PAIMI-eligible individuals/clients: 1,877 children and youth (ages 0 to 18), 

6,946 adults (ages 19 to 64), and 684 older adults (age 65 and older). These individuals 

filed 6,942 complaints alleging abuse, neglect, and/or rights violations. 

• Resolved 91 percent of abuse allegations, 86 percent of neglect allegations, and 92 percent 

of rights violations allegations, and attained outcomes that resulted in positive change for 

the clients served. These positive outcomes included receipt of appropriate medical and 
123

mental disorder treatment; safer, cleaner facility environment; discharge into an 

appropriate community-based setting; and discharge from a nursing facility.

In FY 2018 and FY 2019, SAMHSA funded 57 annual grants to states and territories as well as 

technical assistance activities for the grantees. In FY 2020, SAMHSA anticipates funding 57 

annual grants to states and territories as well as technical assistance activities for the grantees. 

 

Funding History

Fiscal Year Amount

FY 2017 $36,146,000

FY 2018 $36,146,000

FY 2019 $36,146,000

FY 2020 $36,146,000

FY 2021 $14,146,000

Budget Request

The FY 2021 Budget Request is $14.1 million, a decrease of $22.0M from the FY 2020 Enacted. 

The PAIMI programs will continue to focus on addressing abuse and neglect issues for vulnerable 

populations that are institutionalized and advocate for the rights of individuals with mental illness 

as well as continue to assist individuals with serious mental illness increase access to treatment. 

Reductions are being proposed due to the need to realign resources and the need to focus on 

treatment for serious mental illness. 
124

Outputs and Outcomes Table

Program: Protection and Advocacy for Individuals with Mental Illness

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

3.4.12 Number of people served by the PAIMI 

program (Outcome)

FY 2018: 9,507

Target: 11,197

(Target Not Met)

9,507 4,089 -5,418

3.4.19 Number attending public 

education/constituency training and public 

awareness activities (Output)

FY 2018: 80,625

Target: 98,441

(Target Not Met but Improved)

80,625 28,013 -52,612

3.4.21 Percentage of complaints of alleged abuse, 

neglect, and rights violations substantiated and 

not withdrawn by the client that resulted in 

positive change through the restoration of client 

rights, expansion or maintenance of personal 

decision-making, elimination of other barriers to 

personal decision-making, as a result of 

Protection and Advocacy for Individuals with 

Mental Illness (PAIMI) involvement (Outcome)

FY 2018: 91 %

Target: 91 %

(Target Met)

91 % 66 % -25%
125

Department of Health and Human Services

Substance Abuse and Mental Health Services Administration

FY 2021 PAIMI Formula Grant Provisional Allotments

Appropriation $14,146,000, State-Territory Total $13,767,186

CFDA # 93.138

State/Territory

FY 2019 

Final

FY 2020

Enacted

FY 2021

President's 

Budget

FY 2021

+/-

FY 2020

Alabama $457,665 $454,402 $179,846 -$274,556

Alaska 428,000 428,000 167,500 -260,500

Arizona 638,784 641,505 256,995 -384,510

Arkansas 428,000 428,000 167,500 -260,500

California 3,064,413 3,043,159 1,185,579 -1,857,580

Colorado 449,205 450,031 177,423 -272,608

Connecticut 428,000 428,000 167,500 -260,500

Delaware 428,000 428,000 167,500 -260,500

District of Columbia 428,000 428,000 167,500 -260,500

Florida 1,776,069 1,801,228 715,927 -1,085,301

Georgia 929,003 931,818 367,521 -564,297

Hawaii 428,000 428,000 167,500 -260,500

Idaho 428,000 428,000 167,500 -260,500

Illinois 1,039,636 1,031,488 402,225 -629,263

Indiana 590,775 588,634 232,046 -356,588

Iowa 428,000 428,000 167,500 -260,500

Kansas 428,000 428,000 167,500 -260,500

Kentucky 428,000 428,000 167,500 -260,500

Louisiana 428,000 428,000 167,500 -260,500

Maine 428,000 428,000 167,500 -260,500

Maryland 463,525 462,191 181,371 -280,820

Massachusetts 502,083 500,268 196,290 -303,978

Michigan 872,164 869,127 341,823 -527,304

Minnesota 447,375 448,703 176,143 -272,560

Mississippi 428,000 428,000 167,500 -260,500

Missouri 543,808 540,864 211,043 -329,821

Montana 428,000 428,000 167,500 -260,500

Nebraska 428,000 428,000 167,500 -260,500

Nevada 428,000 428,000 167,500 -260,500

New Hampshire 428,000 428,000 167,500 -260,500
126

Department of Health and Human Services

Substance Abuse and Mental Health Services Administration

FY 2021 PAIMI Formula Grant Provisional Allotments

Appropriation $14,146,000, State-Territory Total $13,767,186

CFDA # 93.138

State/Territory

FY 2019 

Final

FY 2020

Enacted

FY 2021

President's 

Budget

FY 2021

+/-

FY 2020

New Jersey 671,867 670,077 258,743 -$411,334

New Mexico 428,000 428,000 167,500 -260,500

New York 1,503,880 1,476,892 566,045 -910,847

North Carolina 913,289 917,038 364,293 -552,745

North Dakota 428,000 428,000 167,500 -260,500

Ohio 1,016,255 1,011,130 398,391 -612,739

Oklahoma 428,000 428,000 167,500 -260,500

Oregon 428,000 428,000 167,500 -260,500

Pennsylvania 1,048,742 1,040,125 406,422 -633,703

Rhode Island 428,000 428,000 167,500 -260,500

South Carolina 462,839 463,238 183,603 -279,635

South Dakota 428,000 428,000 167,500 -260,500

Tennessee 590,750 590,472 235,410 -355,062

Texas 2,392,318 2,437,992 961,957 -1,476,035

Utah 428,000 428,000 167,500 -260,500

Vermont 428,000 428,000 167,500 -260,500

Virginia 676,109 677,110 266,758 -410,352

Washington 577,556 578,507 228,367 -350,140

West Virginia 428,000 428,000 167,500 -260,500

Wisconsin 493,546 490,949 192,467 -298,482

Wyoming 428,000 428,000 167,500 -260,500

Puerto Rico 511,100 512,416 199,198 -313,218

American Samoa 229,300 229,300 89,700 -139,600

Guam 229,300 229,300 89,700 -139,600

American Indian 

Consortium 229,300 229,300 0 -229,300

Northern Mariana Islands 229,300 229,300 89,700 -139,600

Virgin Islands 229,300 229,300 89,700 -139,600
127

Certified Community Behavioral Health Clinic (CCBHC)

(Dollars in thousands)

Program

FY 2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 2020

Certified Community Behavioral Health Clinic...... $150,000 $200,000 $225,000 $25,000

Authorizing Legislation ........................................... Section 520A of the Public Health Service Act

FY 2021 Authorization ................................................................................................. $150,000,000

Allocation Method ..............................................................................Competitive Grants/Contracts

Eligible Entities.......................................Certified Community Behavioral Health Clinics, 

Community-based Behavioral Health Clinics

Program Description and Accomplishments

It is estimated that more than 10 million adults 18 and older had a serious mental illness (SMI), 

more than 17 million adults misused prescription drugs, and about 20 million adults had an illicit 

drug or alcohol use disorder in the past year.37 While effective treatment and supportive services 

exist, many individuals with behavioral health conditions do not receive the help they need. When 

they do try to access services, they may face significant delays and/or get connected to incomplete, 

disconnected, or uncoordinated care. Even people who receive some services, such as medication 

or talk therapy, often do not have access to the complete range of supports they need, such as help 

to get them through a crisis, manage co-occurring physical health problems, find and sustain 

employment, and maintain a safe place to live in the community. 

Congress created a new approach to addressing these issues through Certified Community 

Behavioral Health Clinics (CCBHCs) as a part of the Protecting Access to Medicare Act of 2014. 

CCBHC’s ensure access to and coordination of care so that individuals receive timely diagnosis, 

treatment, and recovery support services. Through this program, HHS has established criteria for 

clinics to be certified as CCBHCs. These criteria cover six administrative areas that CCBHCs must 

address to be certified: (1) staffing; (2) availability and accessibility of services; (3) care 

coordination; (4) scope of services; (5) quality and other reporting; and (6) organizational authority. 

In FY 2016, SAMHSA assisted 24 states through planning grants to be eligible for a CCBHC 

demonstration in FY 2016, and in FY 2017, CMS launched the demonstration program, which 

supports CCBHCs in eight states through a Medicaid prospective payment system. 

In FY 2018, SAMHSA implemented the CCBHC Expansion (CCBHC-E) grant program and 

awarded 52 grants to create new CCBHC’s expansions. Eligibility for the CCBHC-E grants was 

limited to the 24 states that participated in the FY 2016 Planning Grants for Certified Community 

Behavioral Health Clinics Grant Program. The CCBHC-E program is designed to increase access 

to and improve the quality of community behavioral health services. CCBHCs funded under this 

program must provide access to services for individuals with serious mental illness (SMI) or 

substance use disorders (SUD), including opioid disorders; children and adolescents with serious 

emotional disturbance (SED); and individuals with co-occurring mental and substance use disorders 

(COD). Crisis services are a required element of the CCBHC model. SAMHSA expects that this 

 37 SAMHSA, Center for Behavioral Health Statistics and Quality. (2017, September 7). Results

from the 2016 National Survey on Drug Use and Health: Detailed tables. Retrieved from

https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2016/NSDUH-DetTabs-2016.pdf
128

program will improve the behavioral health of individuals across the nation by providing increased 

access to a good range of services. These include: comprehensive community-based mental and 

substance use disorder services; treatment of co-occurring disorders; advance the integration of 

behavioral health with physical health care; assimilate and utilize evidence-based practices on a 

more consistent basis, and promote improved access to high quality care. Broad uptake of the 

CCBHC model solves a number of access and quality problems that exist in our current national 

landscape of services for persons with SMI and SED. 

Since FY 2018, CCBHC-E grantees have served over 24,000 individuals. CCBHC-E grantees have 

increased the availability of critical services, improved staffing and training, reduced wait times, 

enhanced the integration of physical and behavioral health care, expanded addiction treatment 

capacity including Medication Assisted Treatment (MAT) for opioid use disorder. CCBHC-E’s 

have improved the use of data, improved services to veterans and service members, and provided 

increased outreach and engagement with a variety of vulnerable populations.

The table below provides a demographic breakdown of the clients served by the CCBHCs.

Demographics %

Race 

 American Indian 4.4%

 Asian 1.4%

 Black 26.3%

 Native Hawaiian/ Alaska Native 1.0%

 White 75.0%

Ethnicity 

 Hispanic 13.4%

 Non-Hispanic 86.6%

Gender 

 Male 47.0%

 Female 52.3%

 Transgender 0.4%

 Other 0.3%

Age 

17 and under 22.0%

18 through 25 12.9%

26 through 45 37.4%

46 through 65 26.1%

66 and older 2.8%

A total of 64 providers are currently supported by the CCBHC program. The table below includes 

the amount of CCBHC-E funding each state received in FY 2018 and FY 2019.
129

States Total Award

Colorado $4,000,000

Connecticut $3,815,534

Iowa $5,563,152

Illinois $4,000,000

Indiana $7,999,981

Kentucky $7,457,235

Massachusetts $13,375,446

Maryland $7,995,718

Michigan $29,712,939

Minnesota $6,615,717

Missouri $11,019,027

North Carolina $3,519,522

New Jersey $20,644,595

Nevada $4,000,000

New York $27,119,620

Oklahoma $15,338,751

Oregon $7,099,584

Pennsylvania $8,586,498

Rhode Island $2,000,000

Texas $22,534,339

Virginia $5,792,794

In FY 2019, SAMHSA provided funding for 52 continuation grants and awarded 12 new grants. In 

FY 2020, SAMHSA anticipates funding 12 continuation grants and a new cohort of 97 grants. 

Data from intake to most recent reassessment for individuals served in the CCBHC program 

demonstrate that as of January 2020, clients have 61.6% percent reduction in hospitalization and 

62.1% percent reduction in Emergency Department (ED) visits. Additionally, the data demonstrates 

that 15.2% had an increase in employment or started going to school, 30.4% increase in mental 

health functioning in everyday life

Funding History

Fiscal Year Amount

FY 2017 $---

FY 2018 $100,000,000

FY 2019 $150,000,000

FY 2020 $200,000,000

FY 2021 $225,000,000
130

Budget Request

The FY 2021 President’s Budget is $225.0 million, an increase of $25.0 million from the FY 2020 

Enacted. SAMHSA requests funding to support 98 CCBHC-C continuation grants and a new cohort 

of 10 grants to continue the improvement of mental disorder treatment, services, and interventions 

for children and adults. 
131

Outputs and Outcomes Table

Program: Certified Community Behavioral Health Clinic

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

3.4.10 Percentage of clients receiving 

services who report positive 

functioning at 6 months follow-up. 

(Outcome)

FY 2019: 57.3

Target: 60.0

(Target Not Met)

57.3 60 +2.7%

3.4.11 Percentage of clients receiving 

services who are currently employed 

at 6 month follow-up. (Outcome)

FY 2019: 46.7

Target: 39.0

(Target Exceeded)

46.7 50 +3.3%

3.4.12 Percentage of clients receiving 

services who have a permanent place 

to live in the community at 6 month 

follow-up. (Outcome)

FY 2019: 64.8

Target: 73.0

(Target Not Met)

64.8 73 +8.2%

3.5.10 Number of individuals served 

by the program (Output)

FY 2019: 30,742.0

Target: 25,000.0

(Target Exceeded)

30,742.0 40,887 +10,145
132

SAMHSA/Mental Health

Certified Community Behavioral Health Clinics

Mechanism Table 

(Dollars in thousands)

Program Activity

FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

No. Amount No. Amount No. Amount

Certified Community Behavioral Health Clinics

Grants/Cooperative Agreements

Continuations....................................................................... 52 $96,689 12 $23,023 97 $197,401

New/Competing.................................................................... 12 23,124 97 197,401 10 19,814

Subtotal............................................................................... 64 119,813 109 220,425 107 217,215

Contracts

Continuations....................................................................... --- 30,187 --- 6,165 --- 7,785

New/Competing.................................................................... --- --- --- --- --- ---

Subtotal............................................................................... --- 30,187 --- 6,165 --- 7,785

Total, Certified Community Behavioral Health Clinics 64 $150,000 109 $226,589 107 $225,000

FY 2019 Enacted $150,000

FY 2018 Carryover $1,048

FY 2019 Carryover $25,541

Carryover from FY 2019 and FY 2018 -$26,589

FY 2020 Enacted $200,000
133

Community Mental Health Services Block Grant (MHBG)

(Dollars in thousands)

Authorizing Legislation...............................Sections 1911 of the Public Health Service Act

FY 2021 Authorization ................................................................................................$532,571,000

Allocation Method .....................................................................................................Formula Grant

Eligible Entities..................States, Territories, Freely Associated States, and District of Columbia

Program Description and Accomplishments

According to the 2018 National Survey on Drug Use and Health (NSDUH)38, 4.6% of adults aged 

18 and older had a serious mental illness (SMI) in 2018 – an estimated 11,373,000 individuals. Of 

those, only 5,669,155 adults, or 50 percent, with SMI received services from the Community Mental 

Health Services Block Grant (MHBG) in 2018. 

Since 1992, the MHBG has been a significant “safety net” source of funding for mental health 

services for some of the most at-risk populations across the country. Together, SAMHSA’s block 

grants support the provision of services and related support activities to approximately 7,000,000

individuals with mental and substance use conditions in any given year. The MHBG’s flexibility 

and stability have made it a vital support for public mental health systems.

States rely on the MHBG for delivery of services and for an array of non-clinical coordination and 

support services that are not supported by Medicaid or other third party insurance to strengthen 

their service systems. 

The MHBG distributes funds to 59 eligible states and territories and freely associated states through 

a formula based upon specified economic and demographic factors.39 The MHBG distributes funds 

for a variety of services and for planning, administration, and educational activities. By statute, 

these services and activities must support community-based mental health services for children with 

serious emotional disturbances and adults with serious mental illness. MHBG services include: 

 38 Substance Abuse and Mental Health Services Administration. (2019). Key substance use and mental health 

indicators in the United States: Results from the 2018 National Survey on Drug Use and Health (HHS Publication No. 

PEP19-5068, NSDUH Series H-54). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance 

Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/

39 Territories include Guam, Puerto Rico, the Northern Mariana Islands, U.S. Virgin Islands and American Samoa. 

Freely Associated States, which have signed Compacts of Free Association with the United States, include the Republic 

of Palau, Federated States of Micronesia and Republic of the Marshall Islands. See 

http://www.doi.gov//oia/islands/index.cfm. Further information about the Block Grant program can be found on 

SAMHSA’s Web site at http://www.samhsa.gov/grants/block-grants

Program

FY 2019

 Final

FY 2020 

Enacted

 FY 2021

President's 

Budget

FY 2021 

+/-

 FY 2020

Community Mental Health Services Block Grant................................ $722,571 $722,571 $757,571 $35,000

Budget Authority (non-add).......................................................... 701,532 701,532 736,532 35,000

PHS Evaluation Funds (non-add).................................................. 21,039 21,039 21,039 ---
134

outpatient treatment for serious mental illnesses, such as schizophrenia and bipolar disorders; 

supported employment and supported housing; rehabilitation services; crisis stabilization and case 

management; peer specialist and consumer-directed services; wraparound services for children and 

families; jail diversion programs; and services for at-risk populations (e.g., individuals, who 

experience homelessness, those in rural and frontier areas, military families, and veterans). 

Through the administration of the MHBG, SAMHSA supports implementation of practices 

demonstrated and proven effective in the Mental Health Programs of Regional and National 

Significance (PRNS) portfolio. 

The MHBG statute provides for a five percent administrative set-aside that allows SAMHSA to 

assist the states and territories in the development of their mental health systems through the support 

of technical assistance, data collection, and evaluation activities. States also use MHBG funds, 

along with other funding sources, to support training for staff and implementation of evidencebased practices and other promising practices for the treatment of mental disorders, improved 

business practices, use of health information technology, and integration of physical and behavioral 

health services. 

Due to the high prevalence of both adolescent and adult co-occurring mental illness and 

drug/alcohol addiction, SAMHSA strongly encourages coordination between MHBG programs and 

those supported by the Substance Abuse Prevention and Treatment Block Grant (SABG) as well as 

other SAMHSA-funded efforts such as the systems of care for children and adolescents supported 

through the Children’s Mental Health Initiative. 
135

According to the 2018 National Outcome Measures (NOMS) Report, the MHBG served 7,808,416 

clients through the State Mental Health Systems. The table below provides demographics on the 

clients served.

Mental Health Block Grant Demographics

Adults 5,669,155

Children 2,129,471

Female 51%

Male 49%

Age

0-12 15%

13-17 12%

18-20 5%

20-24 6%

25-44 32%

45-64 25%

65-74 4%

75+ 2%
136

The table below provides evidence-based treatment services utilized by clients served by the 

MHBG.

Evidence-based Treatment Services Utilized

Adults

Supported Housing 2.9%

Supported Employment 2.0%

Assertive Community Treatment 2.1%

Family Psychoeducation 2.8%

Dual Diagnosis Treatment 12%

Illness Self-Management 20%

Medications Management 32%

Children

Therapeutic Foster Care 1.1%

Multi-systemic Therapy 3.1%

Functional Family Therapy 4.9%

Most block grant recipients are currently reporting on NOMS for public mental health services 

within their state. State-level outcome data for mental health are currently reported by State Mental 

Health Authorities. The following outcomes for all people served by the publicly funded mental 

health system during 2018 show that:
137

• For the 57 states and territories that reported data in the Employment Domain, 

22.2 percent of the mental health consumers were in competitive employment;

• For the 56 states and territories that reported data in the Housing Domain, 83.5 percent of 

the mental health consumers were living in private residences; 

• For the 58 states and territories that reported data in the Access/Capacity Domain, state 

mental health agencies provided mental health services for approximately 23.69 people 

per 1,000 population; 

• For the 46 states and territories that reported data in the Retention Domain, only 

7.2 percent of the patients returned to a state psychiatric hospital within 30 days of state 

hospital discharge; and

• For the 50 states and territories that reported data in the Perception of Care Domain, 80.4 

percent of adult mental health consumers improved functioning as a direct result of the 

mental health services they received. 

Set-aside for Evidence-based Programs that Address the Needs of Individuals with Early Serious 

Mental Illness

States are required to set aside ten percent of their MHBG funds to support “evidence-based 

programs that address the needs of individuals with early serious mental illness, including psychotic 

disorders.”40 The number of states with fully implemented operating first-episode treatment 

programs is 52 and SAMHSA continues to monitor and ensure that the set-aside program is solely 

used to address first-episode psychosis. 

Beginning in September 2016, SAMHSA, in partnership with National Institute of Mental Health 

(NIMH) and the Office of the Assistant Secretary for Planning and Evaluation (ASPE), initiated a 

3-year evaluation study of the programs funded through the MHBG set-aside to ascertain the 

effectiveness of these First Episode Psychosis programs. The study, which focused on services in 

36 diverse programs, collected clinical outcome data and conducted fidelity assessments. The 

results indicate that these evidence based programs lead to statistically significant improvements in 

the health and well-being of individuals who participate in them, including reductions in 

hospitalization (-79 percent) and emergency room visits (-71 percent), criminal justice involvement 

(-41 percent), and suicide attempts (-66 percent). Furthermore, the percentage of individuals who 

became employed or returned to school while in these programs increased by about 50 percent. 

 40 http://www.samhsa.gov/sites/default/files/mhbg-5-percent-set-aside-guidance.pdf
138

The table below identifies activities, which have been implemented with the 10 percent set-aside. 

State FY 2019

10% Set 

Aside 

Allotment

Program Description

Alabama $995,828 Statewide EASA (Early Assessment and Support Alliance) 

program model is being developed and implemented. 

Alaska $140,636 The state is implementing a CSC program based on OnTrack in 

Wasilla. 

American 

Samoa

$13,432

Training school counselors and administrators on screening and 

assessment for signs and symptoms of psychosis for ages 14-20

Arizona $1,837,317

State contracts with three Regional Behavioral Health 

Authorities (RBHAs) to provide services to members 

experiencing first episodes of psychosis (FEP). A total of nine 

programs offer Coordinated Specialty Care (CSC) services in 

Arizona.

Arkansas $599,758 Developing portions of CSC model in thirteen locations.

California $9,271,544 Forty-one CSC programs, from several different models, are in 

various states of development throughout CA. Thirty-seven are 

fully operational. 

Colorado $1,318,924 Implementing seven CSC, utilizing EASA programs, five of the 

programs are in urban areas, and two in rural areas.

Connecticut $699,055 State implemented four programs based on two distinct CSC 

models (Potential and STEP).

District of 

Columbia

$160,565

The District’s early intervention program (EIP), the Youth 

Blossom program at Community Connections, is utilizing CSC 

model offers early treatment to young adults (age 16-25) 

experiencing their first psychotic break.

Delaware $159,853

A statewide program, CORE (Community Outreach, Referral 

and Early Intervention), has been implemented. 2 statewide 

CSC programs partially funded by the block grant. under 

18/over 18

Florida $4,499,919 State has implemented five CSC programs. All of these 

programs are based on the Navigate model.

Georgia $2,205,333 State has implemented seven CSC programs. All programs are 

based on the LIGHT-ETP model. 

Guam $42,973 State has begun providing services in the I Fine'na program, 

which is based on OnTrackNY, and also offers ESMI services 

through the OASIS Empowerment Center

Hawaii $360,490 State has implemented a program with three sites in Honolulu 

based on the OnTRACK model.

Idaho $390,776 Three CSC programs have been implemented
139

State FY 2019

10% Set 

Aside 

Allotment

Program Description

Illinois $2,482,421 State has implemented CSC programs in 15 locations 

throughout the state using the CSC program model.

Indiana $1,219,334 State offers two programs based on the PARC model and makes 

use of a "hub and spoke" design. 

Iowa $537,761 State has three functioning CSC programs based on the 

NAVIGATE model. 

Kansas $499,650 State has one fully functional CSC program in Kansas City and 

is operationalizing a second program in Topeka. 

Kentucky $892,253 Eight EASA CSC program sites are available throughout the 

state, with one in the installation phase. State is also using the 

MHBG to support data infrastructure to track outcomes. 

Louisiana $981,811 Three sites are in the process of being implemented. These 

programs are using the Navigate CSC model. 

Maine $271,919 State has implemented one program, Maine Medical 

Center/Portland Identification and Early Referral Program, 

based on the PIER Model in Portland. The state has also 

contracted with the PIER program to train staff at one other 

provider to provide FEP services.

Marshall 

Islands

$18,893 Use the set aside funding to develop first episode outreach 

practices and protocols for individuals experiencing FEP. 

Maryland $1,354,232 The state has implemented four CSC programs, two in 

Baltimore, one in Gaithersburg and one in Catonsville. 

Massachusetts $1,404,074 State has developed two CSC programs, one in Boston and a 

second in western Mass. These programs are using the PREP 

model of CSC. 

Michigan $2,036,326 The State has implemented four CSC programs using the 

NAVIGATE CSC model. 

Federated 

States of 

Micronesia

$26,963 Funds are being used to train staff on the OnTrack CSC model 

in four locations. The state also has developed outreach and 

screening processes in schools and in the community in Majuro, 

Ebeye and Outer Islands.

Minnesota $1,032,051 State has implemented two CSC programs in the Twin Cities 

area and is implementing a third program in Duluth. 

Mississippi $627,232 State is fully implementing the NAVIGATE CSC programs to 

provide training and technical assistance to four CSC teams

Missouri $1,153,154 State has established eight sites spread throughout the state that 

provide ACT-TAY for individuals experiencing an early 

serious mental illness.
140

State FY 2019

10% Set Aside 

Allotment

Program Description

Montana $205,124 The state is implementing the NAVIGATE model in one site.

Nebraska $309,309 The state has implemented OnTrackUSA in two of the six 

behavioral health service regions of the state.

Nevada $720,112 State has implemented two CSC programs: one in the Reno 

area, and a second program in the Las Vegas area using the 

RAISE TEAM approach. The state also funds a third CSC 

program in Carson City that follows the NAVIGATE model.

New 

Hampshire

$242,172 State currently has one FEP program at the Greater Nashua 

Mental Health Center (GNMHC), utilizing the NAVIGATE 

model.

New Jersey $1,928,948 State has implemented and expanded the three CSC teams that 

provide CSC service in all 21 NJ counties. 

New Mexico $403,762 State is expanding access to the NAVIGATE model for 

specialty coordinated care for individuals with FEP through the 

already implemented University of New Mexico EARLY 

program. 

New York $4,062,502 State is spending set-aside funds to expand its existing 

OnTrackNY program to two new sites, for 22 CSC sites 

statewide. These sites will serve urban, rural and less-populated 

areas. 

North Carolina $1,976,970 State supports three CSC for FEP programs as well as a TA FEP 

CSC.

North Dakota $104,146 State implemented CSC services in Fargo, which serves six 

counties in the state.

Northern 

Mariana 

Islands

$13,524 The Community Guidance Center implemented a 

psychoeducation group geared toward family education, which 

will help families and the community better identify FEP 

symptoms in their family or community leading to earlier 

treatment of the client. 

Ohio $2,136,363 State has implemented 14 CSC programs and is currently 

installing three more.

Oklahoma $722,424 State has implemented two NAVIGATE CSC programs in 

Oklahoma City and Tulsa. The state also offers a “Be the 

Change” program for individuals with an early serious mental 

illness in Oklahoma County.

Oregon $1,056,092 The state has implemented 36 EASA CSC programs that 

currently serve all 36 counties in Oregon.

Palau $5,497 One CSC team will be supported in a population area of roughly 

20,000 with 1 percent need annually. 
141

State FY 2019

10% Set Aside 

Allotment

Program Description

Pennsylvania $2,270,722 State offers nine CSC programs in rural and urban areas across 

the state.

Puerto Rico $878,399 The First Episode Psychosis (FEP) Program offers Coordinated 

Specialized Care and Recovery Services to persons of 16 to 35 

years of age who have had a traumatic experience and/or are 

evidencing symptoms of psychosis. In Puerto Rico, two CSC 

projects have been implemented.

Rhode Island $259,296 State is using the entire set-aside amount to serve individuals 

ages 16-25 experiencing a first episode of psychosis.

South Carolina $1,030,604 State is funding four programs for individuals with an early 

serious mental illness, one of which is a CSC program.

South Dakota $144,904 State has implemented two CSC programs in Sioux Falls and 

Rapid City. They have been trained by OnTrackNY.

Tennessee $1,314,378 State uses the MHBG funds to provide OnTrackTN to four sites 

across the state. 

Texas $5,787,967 State offers 10 CSC programs in rural and urban areas across 

the state. These sites serve both indigent and Medicaid-eligible 

populations.

Utah $605,184 State has implemented four CSC/FEP programs, using the PIER 

and EASA CSC Models which are funded through MHBG.

Vermont $118,865 State is continuing to partner with the Vermont Cooperative for 

Practice Improvement and Innovation to facilitate the initiative 

including targeted research, implementation, workforce 

development, outreach and education.

Virgin Islands $27,682 State intends to establish a CSC program according to the 

NAVIGATE model.

Virginia $1,712,716 Eight (8) Virginia community services boards (CSBs) have 

been operating Coordinated Specialty Care (CSC) programs for 

the treatment of youth and young adults experiencing their first 

episode of psychosis (FEP).

Washington $1,604,888 State has established three CSC programs adhering to the 

NAVIGATE CSC Model. In addition, the state is currently 

establishing two more CSC programs.

West Virginia $375,005 State has established one CSC program in the Wheeling area.

Wisconsin $1,189,602 State is continuing to fund the CSC model PROPS program 

operated by JMHC in Madison, which serves three rural 

counties north of Madison. In addition, the state is funding a 

CSC program in Milwaukee.
142

State FY 2019

10% Set Aside 

Allotment

Program Description

Wyoming $79,240 The state has two providers providing CSC FEP programs:

Southwest Counseling Service and Yellowstone Behavioral 

Health Center.
143

 Funding History

Fiscal Year Amount

FY 2012 459,756,000 

FY 2013 436,808,709 

FY 2014 482,571,000 

FY 2015 482,571,000 

FY 2016 532,571,000 

FY 2017 562,571,000 

FY 2018 722,571,000 

FY 2019 722,571,000

FY 2020 722,571,000

FY 2021 757,571,000

Budget Request

The FY 2021 President’s Budget is $757.5 million, an increase of $35.0 million from the FY 2020 

Enacted. With this funding, SAMHSA will continue to address the needs of individuals with SMI 

and SED and will continue to maintain the 10 percent set-aside for evidence-based programs that 

address the needs of individuals with early serious mental illness, including psychotic disorders. 

The set-aside funds help reduce costs to society, as intervening early helps prevent deterioration of 

functioning in individuals experiencing a first episode of serious mental illness. The proposed 

increase of $35 million will support state efforts to build much needed crisis systems to address the 

needs of individuals in mental health crisis in a high quality, expeditious manner. The development 

of these services will promote 24/7 access to well-trained mental health professionals in the time of 

acute mental health crisis. 
144

Outputs and Outcomes Table

Program: Mental Health Block Grant

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

2.3.11 Number of evidence based 

practices (EBPs) implemented (Output)

FY 2018: 4.9 per State

Target: 4.6 per State

(Target Exceeded)

4.9 per State 4.9 per State Maintain

2.3.14 Number of people served by the 

public mental health system (Output)

FY 2018: 7,808,416

Target: 7,339,821

(Target Exceeded)

7,808,416 7,808,416 Maintain

2.3.15 Rate of consumers (adults) 

reporting positively about outcomes 

(Outcome)

FY 2018: 80.4 %

Target: 75.7 %

(Target Exceeded)

80.4 % 80.4 % Maintain

2.3.16 Rate of family members 

(children/adolescents) reporting 

positively about outcomes (Outcome)

FY 2018: 72.3 %

Target: 73.5 %

(Target Not Met)

72.3 % 72.3 % Maintain

2.3.19A: Supported Housing Supported 

Housing: Percentage of the population 

accessing selected evidence-based 

programs among people served by state 

mental health authorities (Outcome)

FY 2019: Result Expected 

December 31, 2020

Target: 3.8 %

(Pending)

3.8 % 3.8 % Maintain

2.3.19B Supported Employment: 

Percentage of the population accessing 

selected evidence-based programs 

among people served by state mental 

health authorities (Outcome)

FY 2019: Result Expected 

December 31, 2020

Target: 2.2 %

(Pending)

2.3 % 2.3 % Maintain

2.3.19C Assertive Community 

Treatment: Percentage of the population 

accessing selected evidence-based 

programs among people served by state 

mental health authorities (Output)

FY 2019: Result Expected 

December 31, 2020

Target: 2.2 %

(Pending)

2.2 % 2.2 % Maintain

2.3.19D Family Psychoeducation: 

Percent of the population accessing 

selected evidence-based programs 

among people served by state mental 

health authorities (Outcome)

FY 2019: Result Expected 

December 31, 2020

Target: 2.1 %

(Pending)

2.2 % 2.2 % Maintain

2.3.19E Dual Diagnosis Treatment: 

Percent of the population accessing 

selected evidence-based programs 

FY 2019: Result Expected 

December 31, 2020

Target: 11.0 %

11.5 % 11.5 % Maintain
145

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

among people served by state mental 

health authorities. (Outcome) (Outcome) (Pending)

2.3.19F Illness Self-Management: 

Percent of the population accessing 

selected evidence-based programs 

among people served by state mental 

health authorities. (Outcome)

FY 2019: Result Expected 

December 31, 2020

Target: 21.0 %

(Pending)

23.0 % 23.0 % Maintain

2.3.19G Medication Management: 

Percent of the population accessing 

selected evidence-based programs 

among people served by state mental 

health authorities. (Outcome)

FY 2019: Result Expected 

December 31, 2020

Target: 33.0

(Pending)

35.0 35.0 Maintain

2.3.19H Treatment Foster Care: Percent 

of the population accessing selected 

evidence-based programs among people 

served by state mental health authorities. 

(Outcome)

FY 2019: Result Expected 

December 31, 2020

Target: 1.7 %

(Pending)

1.9 % 1.9 % Maintain

2.3.19I Multi-Systemic Therapy: Percent 

of the population accessing selected 

evidence-based programs among people 

served by state mental health authorities. 

(Outcome)

FY 2019: Result Expected 

December 31, 2020

Target: 4.3 %

(Pending)

4.7 % 4.7 % Maintain

2.3.19J Functional Family Therapy: 

Percent of the population accessing 

selected evidence-based programs 

among people served by state mental 

health authorities. (Outcome)

FY 2019: Result Expected 

December 31, 2020

Target: 7.5 %

(Pending)

8.5 % 8.5 % Maintain

2.3.81 Percentage of service population 

receiving any evidence based practice 

(Outcome)

FY 2018: 11.8 %

Target: 11.7 %

(Target Exceeded)

11.8 % 11.8 % Maintain
146

Department of Health and Human Services

Substance Abuse and Mental Health Services Administration

 FY 2021 Mental Health Block Grant Final Allotments

Appropriation $757,571,000, State-Territory Total $717,924,864

CFDA # 93.959

State/Territory

FY 2019

Final

FY 2020

Enacted

FY 2021

President's 

Budget

FY 2021

+/-

FY 2020

Alabama $9,958,277 $9,899,084 $10,394,670 $495,586

Alaska 1,406,364 1,480,885 1,626,677 145,792

Arizona 18,373,174 18,493,829 19,763,875 1,270,046

Arkansas 5,997,576 5,986,777 6,291,052 304,275

California 92,715,441 91,832,541 94,198,007 2,365,466

Colorado 13,189,237 13,283,889 14,132,630 848,741

Connecticut 6,690,546 6,761,092 6,972,575 211,483

Delaware 1,598,527 1,582,328 1,675,916 93,588

District Of Columbia 1,605,650 1,603,015 1,702,477 99,462

Florida 44,999,189 45,278,203 47,764,602 2,486,399

Georgia 22,053,331 21,993,812 23,008,264 1,014,452

Hawaii 3,604,901 3,533,598 3,621,418 87,820

Idaho 3,907,763 3,957,780 4,240,878 283,098

Illinois 24,824,212 24,466,019 25,299,678 833,659

Indiana 12,193,343 12,129,344 12,885,791 756,447

Iowa 5,377,612 5,271,887 5,641,860 369,973

Kansas 4,996,496 4,988,410 5,252,201 263,791

Kentucky 8,922,528 8,895,473 9,341,549 446,076

Louisiana 9,818,107 9,780,411 10,421,141 640,730

Maine 2,719,188 2,699,523 2,820,956 121,433

Maryland 13,542,317 13,548,728 14,010,747 462,019

Massachusetts 14,040,737 13,983,098 14,403,343 420,245

Michigan 20,363,260 20,194,039 21,116,415 922,376

Minnesota 10,320,508 10,358,721 10,893,371 534,650

Mississippi 6,272,319 6,220,048 6,575,829 355,781

Missouri 11,531,537 11,522,294 12,107,987 585,693

Montana 2,051,241 2,054,853 2,202,648 147,795

Nebraska 3,093,092 3,069,216 3,302,802 233,586

Nevada 7,201,123 7,279,761 7,608,909 329,148

New Hampshire 2,421,717 2,404,349 2,534,892 130,543
147

Department of Health and Human Services

Substance Abuse and Mental Health Services Administration

 FY 2021 Mental Health Block Grant Final Allotments

Appropriation $757,571,000, State-Territory Total $717,924,864

CFDA # 93.959

State/Territory

FY 2019

Final

FY 2020

Enacted

FY 2021

President's 

Budget

FY 2021

+/-

FY 2020

New Jersey 19,289,480 19,362,783 19,709,615 346,832

New Mexico 4,037,621 4,070,758 4,374,402 303,644

New York 40,625,021 40,459,564 40,325,000 -134,564

North Carolina 19,769,701 19,801,355 20,925,744 1,124,389

North Dakota 1,041,461 1,070,333 1,248,843 178,510

Ohio 21,363,628 21,215,342 22,428,094 1,212,752

Oklahoma 7,224,242 7,295,002 7,913,826 618,824

Oregon 10,560,923 10,607,443 11,406,554 799,111

Pennsylvania 22,707,223 22,533,122 23,599,634 1,066,512

Rhode Island 2,592,959 2,567,486 2,671,519 104,033

South Carolina 10,306,043 10,286,119 10,822,165 536,046

South Dakota 1,449,042 1,446,803 1,551,170 104,367

Tennessee 13,143,779 13,111,226 13,744,076 632,850

Texas 57,879,672 59,374,828 64,901,222 5,526,394

Utah 6,051,844 6,091,444 6,491,269 399,825

Vermont 1,188,649 1,175,538 1,232,085 56,547

Virginia 17,127,156 17,190,658 18,029,452 838,794

Washington 16,048,884 16,051,771 16,727,538 675,767

West Virginia 3,750,048 3,705,898 3,918,993 213,095

Wisconsin 11,896,020 11,793,459 12,409,093 615,634

Wyoming 792,403 812,359 912,537 100,178

American Samoa 134,316 134,614 141,320 6,706

Guam 429,733 437,419 466,485 29,066

Northern 

Marianas 135,240 136,598 144,568 7,970

Puerto Rico 8,783,994 8,760,573 9,160,615 400,042

Palau 54,965 56,014 59,825 3,811

Marshall Islands 188,930 194,820 210,437 15,617

Micronesia 269,633 272,334 288,176 15,842

Virgin Islands 276,820 280,363 297,447 17,084
148

SAMHSA

Substance Abuse Prevention

 Table of Contents

1. Substance Abuse Prevention Appropriation ......................................................................... 148

2. Programs of Regional and National Significance (PRNS)................................................... 149

a) Strategic Prevention Framework..................................................................................... 150

b) Federal Drug-Free Workplace ........................................................................................ 154

c) Minority AIDS................................................................................................................ 158

d) Sober Truth on Preventing Underage Drinking Act (Stop Act) ..................................... 161

e) Center for the Application of Prevention Technologies................................................. 165

f) Science and Service Program Coordination ................................................................... 168

g) Tribal Behavioral Health Grants..................................................................................... 172

h) Minority Fellowship Program......................................................................................... 175

3. PRNS Mechanism Table Summary ...................................................................................... 177

4. PRNS Mechanism Table by Program, Project, and Activity................................................ 178

5. Grant Awards Table.............................................................................................................. 181
149

Substance Abuse Prevention Appropriation

(Dollars in thousands)

FY 2019

Final

FY 2020

Enacted

FY 2021

President's

Budget

FY 2021 

+/-

FY 2020 

Programs of Regional and National Significance............. $205,469 $206,469 $96,985 -$109,484

Total, Substance Abuse Prevention $205,469 $206,469 $96,985 -$109,484

The Substance Abuse Prevention FY 2021 President’s Budget is $96.0 million, reflecting a decrease 

of $109.5 million from the FY 2020 Enacted. This decrease cuts funding for the Strategic 

Prevention Framework program.
150

Programs of Regional and National Significance (PRNS)

Substance Abuse Prevention Appropriation

(Dollars in Thousands)

Programs of Regional & National Significance

FY 2019

Final

FY 2020

Enacted

FY 2021

President's

Budget

FY 2021 

+/-

FY 2020 

Enacted

Capacity:

Strategic Prevention Framework.................................... $119,484 $119,484 $10,000 -$109,484

Strategic Prevention Framework Rx (non-add)......... 10,000 10,000 10,000 ---

Federal Drug-Free Workplace........................................ 4,894 4,894 4,894 ---

First Responder Training (CARA)................................. --- --- --- ---

Improving Access to Overdose Treatment (CARA)...... --- --- --- ---

Minority AIDS................................................................ 41,205 41,205 41,205 ---

Sober Truth on Preventing Underage Drinking Act 

(STOP Act) ...................................................................... 8,000 9,000 9,000 --

Grants to Prevent Prescription Drug/Opioid Overdose 

Related Deaths.................................................................... --- --- --- ---

Tribal Behavioral Health Grants..................................... 20,000 20,000 20,000 ---

Subtotal, Capacity 193,583 194,583 85,099 -$109,484

Science and Service: ---

Center for the Application of Prevention Technologies. 7,493 7,493 7,493 ---

SAP Minority Fellowship Program................................ 321 321 321 ---

Science and Service Program Coordination................... 4,072 4,072 4,072 ---

Subtotal, Science and Service 11,886 11,886 11,886 ---

Total, PRNS $205,469 $206,469 $96,985 -$109,484

Authorizing Legislation.........................................................................................Section 516 of the PHS Act

FY 2021 Authorization....................................................................................................................$211,148,000

Allocation Method.............................................Competitive Grants/Cooperative Agreements/Contracts

Eligible Entities.................................................................................................States, political subdivisions of

 States, Federally Recognized

American Indian/Alaska Native tribe or tribal organizations,

Indian Health Service-operated and contracted health facilities

and programs, public or private nonprofit entities
151

Strategic Prevention Framework

(Dollars in thousands)

Programs of Regional & National Significance

FY 2019

Final

FY 2020

Enacted

FY 2021

President's

Budget

FY 2021

+/-

FY 2020

Strategic Prevention Framework............................................ $119,484 $119,484 $10,000 -$109,484

Strategic Prevention Framework Rx (non-add)................. $10,000 $10,000 $10,000 $---

Authorizing Legislation.........................................................................................Section 516 of the PHS Act

FY 2021 Authorization....................................................................................................................$211,148,000

Allocation Method.............................................Competitive Grants/Cooperative Agreements/Contracts

Eligible Entities....................................................................................................States, Tribes, and Territories

Program Description and Accomplishments

Strategic Prevention Framework (SPF)

Drug and alcohol use are significant public health problems. Youth and adolescents who use 

alcohol and drugs face an increased risk of poor school performance, criminal justice involvement, 

the development of a drug/alcohol addiction, risky sexual behavior, illnesses such as HIV and 

hepatitis, depression and anxiety, and injury and death. The immediate and long-term risks and 

negative outcomes associated with adolescent drug and alcohol use underscore the need for

effective prevention and treatment programs. 

Youth and adolescents use a variety of substances. In 2017, an estimated 30.4 million Americans 

aged 12 or older used illicit drugs in the past 30 days. The illicit drug use estimate for 2017 

continues to be driven primarily by marijuana use and the misuse of prescription pain relievers, 

with 25.9 million individuals who currently use marijuana aged 12 or older (i.e., past 30 day use) 

and 3.2 million people aged 12 or older who reported current misuse of prescription pain relievers.41

Since its inception, the Strategic Prevention Framework – Partnerships for Success (SPF-PFS) 

program has addressed underage drinking among youth and young adults age 12 to 20 and has 

allowed states to prioritize state-identified top data driven substance abuse target areas. In 2017, the 

SPF-PFS program specifically addressed underage drinking and prescription drug misuse among 

youth and young adults. In 2018 the SPF-PFS was designed to address underage drinking among 

youth and young adults age 9 to 20 and has allowed states and tribes, at their discretion to use funds 

to target up to two additional data driven substance abuse prevention priorities addressing ages 9 

and above.

The 2017 National Survey on Drug Use and Health (NSDUH) shows that underage alcohol use 

(i.e., people aged 12 to 20) and binge and heavy drinking use among young adults aged 18 to 25, 

have declined over time but remain a concern. In 2016, 19.7 percent of underage people reported 

current use of alcohol, 11.9 percent reported binge drinking, and 2.5 percent reported heavy alcohol 

use. 

 41 Substance Abuse and Mental Health Services Administration. (2018). Key substance use and mental health 

indicators in the United States: Results from the 2017 National Survey on Drug Use and Health (HHS Publication 

No. SMA 18-5068, NSDUH Series H-53). Rockville, MD: Center for Behavioral Health Statistics and Quality, 

Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/
152

Compared to the previous year’s NSDUH, the binge-drinking rate declined from 12.1 percent to 

11.9 percent, and the rate of heavy drinking declined from 2.8 percent to 2.5 percent. In 2017, 

6.5 percent of adolescents age 12 to 17 (1.9 million individuals) used marijuana in the past month. 42

In FY 2018, SAMHSA funded 74 SPF-PFS grant continuations and 29 new grants. In FY 2019, 

SAMHSA supported 62 SPF-PFS grant continuations and 113 new grants. The SPF-PFS grant 

program addresses one of the nation’s top substance abuse prevention priorities: underage drinking 

among persons ages 9 to 20. At their discretion, states/tribes may also use grant funds to target up 

to two additional, data-driven substance abuse prevention priorities, such as the use of marijuana, 

cocaine, or methamphetamine, etc. by individuals ages 9 and above. SPF-PFS is designed to ensure 

that prevention strategies and messages reach the populations most impacted by substance abuse. 

The program extends current established cross-agency and community-level partnerships by 

connecting substance abuse prevention programming to departments of social services and their 

community service providers. This includes working with populations disproportionately impacted 

by the consequences of substance use; i.e., children entering the foster care system, transitional 

youth, and individuals who support persons with substance abuse issues (women, families, parents, 

caregivers, and young adults). In FY 2020, SAMHSA plans to award up to 92 new grants. 

Strategic Prevention Framework for Prescription Drugs (SPF Rx)

From 1999 to 2016, drug-poisoning death rates more than tripled, from 6.1 per 100,000 to 19.8 per 

100,000. In 2016, there were 63,632 deaths due to drug poisoning. Provisional estimates for 2017 

suggest an increase to 72,287 drug-poisoning deaths.

43 Also, from 1999 to 2016, the age-adjusted 

rate of drug-poisoning deaths increased from 8.2 per 100,000 to 26.2 per 100,000 for males, and 

from 3.9 per 100,000 to 13.4 per 100,000 for females.

The Strategic Prevention Framework for Prescription Drugs assists grantees in developing capacity 

and expertise in the use of data from state run prescription drug monitoring programs (PDMP). 

Grantees have also raised awareness about the dangers of sharing medications and work with 

pharmaceutical and medical communities on the risks of overprescribing to young adults. 

SAMHSA’s program focuses on raising community awareness and bringing prescription drug use 

prevention activities and education to schools, communities, parents, prescribers, and their patients. 

SAMHSA tracks reductions in opioid overdoses and the incorporation of prescription drug 

monitoring data into needs assessments and strategic plans as indicators of program success. 

SAMHSA plans to maintain this level of support for SPF Rx through FY 2021.

 42 Substance Abuse and Mental Health Services Administration. (2018). Key substance use and mental health indicators 

in the United States: Results from the 2017 National Survey on Drug Use and Health (HHS Publication No. SMA 18-

5068, NSDUH Series H-53). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and 

Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/

43 Centers for Disease Control and Prevention. NCHS Data on Drug Poisoning Deaths. 

https://www.cdc.gov/nchs/data/factsheets/factsheet_drug_poisoning.pdf.
153

Program Evaluation

In FY 2018, there was a significant increase in the number of evidence-based practices that were 

implemented by sub-recipient communities in PFS, over 3 times the target amount of 411. The 

target of 238 was also exceeded by over 36 percent in FY 2018 with an increase in the number of 

sub-recipient communities that improved on one or more targeted national outcome measures. The 

goal of the FY 2018 SPF-PFS grant program is to address one of the nation’s top substance misuse 

prevention priorities: underage drinking among people aged 9 to 20. Fifteen (15) states and fourteen 

tribal (14) communities are focusing on alcohol use and at least one other substance, and many are 

focusing their prevention efforts on subpopulations. The American Indian, Alaska Native, and 

Pacific Island grantees have made important contributions to developing the feasibility study of the 

PFS-18 grant program. Because they represent uniquely diverse populations, they present cultural 

considerations and challenges in data collection and analysis that contribute to better understanding 

of the facilitators and barriers to developing locally meaningful data.

The Government Performance and Results Act (GPRA) requires reporting for the Strategic 

Prevention Framework for Prescription Drug (SPF-Rx) program for two measures. The number of 

funded states/tribes that incorporate Prescription Drug Monitoring Program (PDMP) data into their 

strategic plans; and the number of funded states/tribes reporting reductions in opioid overdoses. 

In FY 2017, Grantees reported on the first GPRA measure, the number of funded states/tribes that 

incorporate PDMP data into their strategic plans, to the Substance Abuse and Mental Health 

Services Agency’s Performance Accountability and Reporting System (SPARS). According to data 

provided by SPARS, 6 out of 11 responding grantees (55%) incorporated PDMP data into their 

strategic plans in FY2017. Also, in FY2017, the first year of funding, seven grantees began 

implementing interventions.

Funding History

Fiscal Year Amount

FY 2017 $119,484,000

FY 2018 $119,484,000

FY 2019 $119,484,000

FY 2020 $119,484,000

FY 2021 $10,000,000

Budget Request

The FY 2021 President’s Budget is $10.0 million, reflecting a decrease of $109.5 million from the 

FY 2020 Enacted. Funding for the SPF Rx program will be maintained in its entirety ($10.0 

million) for 25 continuation grants. Funding to support SPF PFS is eliminated. States can use the 

prevention set-aside in the Substance Abuse Block Grant to support prevention activities. 
154

Outputs and Outcomes Table

Program: Partnerships for Success

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

2.3.79 Number of EBPs implemented 

by sub-recipient communities (Output)

FY 2018: 1,274

Target: 411

(Target Exceeded)

1,274 Discontinued -1,274

2.3.80 Number of sub-recipient 

communities that improved on one or 

more targeted NOMs indicators 

(Outcome)

FY 2018: 325

Target: 238

(Target Exceeded)

325 Discontinued -325

Program: Strategic Prevention Framework Rx

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

3.3.12 Percent of funded states 

reporting reductions in opioid 

overdoses (Outcome)

FY 2017: 69 %

Target: 55 %

(Target Exceeded)

69 % 69 % Maintain

3.3.13 Percent of grantees that 

reported taking steps to enhance 

access to and use of PDMP data at the 

grantee level. (Outcome)

FY 2017: 83.0

Target: 83.0

(Baseline)

83.0 83.0 Maintain
155

Federal Drug-Free Workplace

(Dollars in thousands)

Programs of Regional & National Significance

FY 2019

Final

FY 2020

Enacted

FY 2021

President's

Budget

FY 2021

+/-

FY 2020

Federal Drug-Free Workplace............................................ $4,894 $4,894 $4,894 $---

Authorizing Legislation........................................................................................Section 516 of the PHS Act

FY 2021 Authorization....................................................................................................................$211,148,000

Allocation Method.................................................................................Inter-Agency Agreements/Contracts

Eligible Entities....................................................................................Federal Agencies, Regulated Entities

(e.g., Department of Transportation, Nuclear Regulatory Commission),

HHS- Certified Laboratories

Program Descriptions and Accomplishments

The use of alcohol, illicit, prescription, and over-the counter drugs, including polysubstance use, 

are widespread and have a variety of negative consequences, particularly in the workplace. This 

program continues to examine emerging issues especially among young adults and high risk 

workplaces such as: increased legal/illegal opioid/synthetic opioid use and polysubstance use 

leading to injuries, overdoses, and death. Employers with successful drug-free workplace programs 

report decreases in absenteeism, accidents, downtime, turnover, and theft; increases in productivity; 

and overall improved morale. Additionally, they report better health status among many employees 

and family members and decreased use of medical benefits. Many organizations with drug-free 

workplace programs qualify for health care incentives, for example, decreased premium costs for 

certain kinds of insurance, such as Workers’ Compensation. 

The Federal Drug-Free Workplace Programs (DFWP) ensure employees in national security, public 

health, and public safety positions are tested for the use of illegal drugs and the misuse of

prescription drugs and ensure the laboratories that perform this drug testing are inspected and 

certified by HHS. Through this program, the federal government is able to avoid lost productivity 

and reduce absenteeism, injuries, and fatalities. 

SAMHSA implements the Federal Drug-Free Workplace Programs, which consist of two principal 

activities mandated by Executive Order (E.O.) 12564 and Public Law (P.L.) 100-71. These include: 

1) oversight of the Federal Drug-Free Workplace Programs, aimed at the elimination of the use of 

illegal drugs and the misuse of prescription drugs within Executive Branch agencies and the 

federally-regulated industries, and 2) oversight of the National Laboratory Certification Program 

(NLCP), which certifies laboratories to conduct forensic drug testing for federal agencies and 

federally-regulated industries. The private sector also uses the HHS-certified laboratories. 

Since 1987, SAMHSA has funded the Drug-Free Workplace drug testing activities including the 

NLCP and the Drug Testing Advisory Board (DTAB). Activities continued in FY 2019 under the 

NLCP contract. The NLCP oversees the certification of the labs that perform drug testing under 

the Drug-Free Workplace Programs. DTAB will continue to provide recommendations to the 

Assistant Secretary for Mental Health and Substance Use based on an ongoing review of the 

direction, scope, balance, and emphasis of SAMHSA’s drug testing activities and the NLCP. 
156

On January 10, 2012, SAMHSA approved the DTAB’s recommendations to revise the mandatory 

guidelines to include oral fluid as an alternative specimen to urine as well as include additional 

Schedule II prescription drug medications (e.g., oxycodone, oxymorphone, hydrocodone and 

hydromorphone). On August 7, 2015, SAMHSA approved the DTAB’s recommendations to pursue 

hair as an alternative specimen in the Mandatory Guidelines for Federal Workplace Drug Testing 

Programs. 

CSAP’s Workplace Helpline supports the drug-free workplace program. The helpline is a toll free 

telephone service (800-WORKPLACE) that answers questions from federal agencies, the public 

and private sectors about drug testing in the workplace. 

Continued funding for the Federal Drug-Free Workplace Programs has ensured the testing of 

federal employees in national security, public health, and public safety positions for the use of 

illegal drugs, the misuse of prescription drugs, and the inspection certification of HHS-certified 

laboratories for the past four years.

Benefits of the program

The Drug Free Workplace Program (DFWP) helps drug users refrain from using illegal drugs, as 

well as demonstrates that illegal drug use will not be tolerated in the federal workplace. The DFWP 

achieves this through policies and procedures including drug testing which allows for the drug 

testing of all executive branch employees. A key program aim is to eliminate illicit drug use in 

federal workplaces and oversee the National Laboratory Certification Program (NLCP) which 

certifies laboratories to conduct forensic drug testing for federal agencies and federally regulated 

industries. 

The program also publishes mandatory guidelines which establish the scientific and technical 

aspects of the program and standardize the laboratory procedures and electronic chain of custody 

which includes specifying the drug to be tested for and setting laboratory certification standards 

through the NLCP. 

Additionally, the DFWP aids in preventing the need for substance abuse recovery programs, helps 

reduce health insurance costs, improves attendance and employee productivity, provides a safer 

workplace with reduced accidents and provides EAP services to employees with substance abuse 

disorders.

The Drug Free Workplace Program helps drug users refrain from using illegal drugs, as well as 

demonstrates that illegal drug use will not be tolerated in the federal workplace.

The benefits of this program include: 

• DTAB continued evaluation of the scientific supportability of hair as an alternative 

specimen to urine and oral fluids in the Mandatory Guidelines for Federal Workplace Drug 

Testing Programs;

• Examining changes in drug testing methodologies, changes in law, and new and emerging 

issues related to the Farm Bill, marijuana (and potency), cannabidiol (CBD), opioids, 

synthetic drugs, polysubstance use/misuse, and hair/oral fluid drug testing; 

• Continued use of subject matter experts and partnering with other federal agencies to 

establish the scientific standards set out in the mandatory guidelines; 
157

• Research of hair as an alternative specimen for scientific supportability and inclusion in the 

Mandatory Guidelines; 

• Technical and scientific leadership for federal agencies on marijuana testing; and 

• Analysis and guidance of/on emerging issues (e.g. opioids/synthetic opioids; polysubstance 

use; young adults, high-risk workplaces)

Funding History

Fiscal Year Amount

FY 2017 $4,894,000

FY 2018 $4,894,000

FY 2019 $4,894,000

FY 2020 $4,894,000

FY 2021 $4,894000

Budget Request

The FY 2021 President’s Budget is $4.8 million, level with the FY 2020 Enacted. In FY 2021, 

SAMHSA will continue oversight of the Executive Branch Agencies’ Federal Drug-Free 

Workplace Programs. This includes review of Federal Drug-Free Workplace plans from those 

federal agencies that perform federal employee testing, random testing of those designated testing 

positions of national security, public health, and public safety, and testing for illegal drug use and 

the misuse of prescription drugs. SAMHSA will continue its oversight role for the inspection and 

certification of the HHS-certified laboratories. 
158

Outputs and Outcomes Table

Program: Federal Drug-Free Workplace

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

6.0 Number of HHS Certified 

Labs (Output)

FY 2018: 26.0 certified labs

Target: 26.0 certified labs

(Baseline)

28.0 certified labs 31.0 certified labs +3 certified labs
159

Minority AIDS

(Dollars in thousands)

Programs of Regional & National Significance

FY 2019

Final

FY 2020

Enacted

FY 2021

President's

Budget

FY 2021

+/-

FY 2020

Minority AIDS....................................................................... $41,205 $41,205 $41,205 $---

Authorizing Legislation........................................................................................Section 516 of the PHS Act

FY 2021 Authorization....................................................................................................................$211,148,000

Allocation Method............................................Competitive Grants/Cooperative Agreements/Contracts

Eligible Entities......................................Local Government Entities, Community-based Organization,

(e.g., Department of Transportation, Nuclear Regulatory Commission),

Minority Serving Institutions, and Institutions of Higher Education

Program Description and Accomplishments

The National HIV/AIDS Strategy: Updated to 2020 indicates that the HIV epidemic still exists and 

the needs of people living with HIV and those who are at-risk for infection continue to evolve. It 

also notes that to be effective, the federal response must adapt in order to respond to changing needs 

and funding levels as well as new threats, such as those presented by the opioid crisis.44 

Approximately 39,000 people become infected with HIV each year.45 In addition, because HIV 

and viral hepatitis share common modes of transmission, one third of HIV infected individuals are 

also infected with hepatitis C.46 Hepatitis C cases are also increasing because of the use of injection 

drugs.

The Minority AIDS program supports activities that assist grantees in building a solid foundation 

for delivering and sustaining quality and accessible state-of-the-science substance misuse and HIV 

prevention services. The program aims to engage community-level domestic public and private 

non-profit entities, tribes, and tribal organizations in order to prevent and reduce the onset of 

substance misuse and transmission of HIV/AIDS among at-risk populations, including racial/ethnic 

minority youth and young adults, ages 13 to 24. SAMHSA works with college and university 

clinics/wellness centers and community-based providers that can provide comprehensive substance 

abuse and HIV prevention strategies. These strategies combine education and awareness programs, 

social marketing campaigns, and HIV and viral hepatitis testing services in non-traditional settings 

with substance misuse and HIV prevention programming for the population of focus. Because of 

the high rate of HIV/AIDS and hepatitis co-morbidity, this program includes viral hepatitis 

prevention and education training. The MAI program, along with many other HIV/AIDS programs 

across HHS, contributes to the goals of the President’s new initiative to eliminate new HIV 

infections in our nation. Ending the HIV Epidemic: A Plan for America.

SAMHSA has helped to prevent HIV and hepatitis infection acquired through substance abuse and 

misuse. SAMHSA’s Minority AIDS and viral hepatitis prevention programs have included a focus 

 44 National HIV/AIDS Strategy for the United States: Update in 2020 45 CDC: HIV in the United States at a Glance: https://www.cdc.gov/hiv/pdf/statistics/overview/cdc-hiv-usataglance.pdf

46 U.S. Department of Health and Human Services: Secretary’s Minority AIDS Initiative Fund: 2017: HIV BASICS: 

Staying in HIV Care: Other Related Health Issues: Hepatitis B & C: Hepatitis B Virus and Hepatitis C Virus Infection, 

https://www.hiv.gov/hiv-basics/staying-in-hiv-care/other-related-health-issues/hepatitis-b-and-c
160

on community-based organizations and minority serving institutions and a focus on the continuum 

of care. SAMHSA supported 105 grant continuations and 37 new grant awards in FY 2018. 

In FY 2019, SAMHSA supported 142 grant continuations and six new grant awards. SAMHSA 

plans to support 94 grant continuations and 50 new grants in FY 2020. 

Program Evaluation

The most recent cross-site analysis of the MAI programs have produce the following results:

• Significant improvements in all substance abuse prevention knowledge and attitude 

measures and significant reductions in past-30-day alcohol and marijuana use. These 

substances are important risk factors for HIV and viral hepatitis.

• Based on the latest data available, 39,978 people received an HIV test in 2018 using grant 

funds. Of those tested, 17,913 received an HIV test for the first time.

• A total of 261 people tested positive for HIV. Of those who tested positive for HIV, 234 

were referred to treatment.

• In addition, 7,814 people were tested for viral hepatitis of which 394 tested positive. 332 of 

the people who tested positive for viral hepatitis were referred to treatment.

Funding History

Fiscal Year Amount

FY 2017 $40,405,000

FY 2018 $41,205,000

FY 2019 $41,205,000

FY 2020 $41,205,000

FY 2021 $41,205,000

Budget Request 

The FY 2021 President’s Budget is $41.2 million, level with the FY 2020 Enacted, which 

SAMHSA plans to use to support 112 continuations and 35 new grant awards.
161

Outputs and Outcomes Table

Program: Minority AIDS Initiative

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

2.3.56 Number of program participants 

exposed to substance abuse prevention 

education services (Output)

FY 2018: 6,777

Target: 2,580

(Target Exceeded)

6,777 6,777 Maintain

2.3.85a Number of persons tested for 

HIV through the Minority AIDS 

Initiative prevention activities (Output)

FY 2018: 31,811

Target: 21,137

(Target Exceeded)

31,811 31,811 Maintain

2.3.90 Percentage of program 

participants who reported reduced 

binge drinking at follow-up. (Outcome)

FY 2018: 57.4 %

Target: 57.4 %

(Baseline)

57.4 % 57.4 % Maintain
162

Sober Truth on Preventing Underage Drinking Act (STOP Act)

(Dollars in thousands)

Programs of Regional & National Significance

FY 2019

Final

FY 2020

Enacted

FY 2021

President's

Budget

FY 2021

+/-

FY 2020

Sober Truth on Preventing Underage Drinking Act (STOP 

Act).................................................................................... $8,000 $9,000 $9,000 $-

Authorizing Legislation....................................................................................Section 519B of the PHS Act

FY 2021 Authorization....................................................................................................................$211,148,000

Allocation Method.............................................................................................Competitive Grants/Contracts

Eligible Entities......................................................Current and former Drug Free Communities grantees

Program Description and Accomplishments

Among Americans under age 21, alcohol is the most frequently used substance, used more often 

than tobacco, marijuana, or other illicit drugs. Nineteen percent of 12- to 20-year-olds report having 

used alcohol in the previous month. Underage alcohol consumption is a persistent and serious public 

health challenge, resulting in thousands of deaths each year through motor vehicle crashes, 

violence, suicide, alcohol poisoning, and other causes. Underage drinking is also implicated in 

sexual assault and other crimes, impaired brain function, decreased academic performance, and the 

increased risk of developing an alcohol use disorder later in life.47

The Sober Truth on Preventing Underage Drinking Act (STOP Act) of 2006 (Public Law 109-422) 

was the nation’s first comprehensive legislation on underage drinking. The STOP Act was 

reauthorized in 2016 as part of the 21st Century Cures Act. The STOP Act requires the Secretary of 

Health and Human Services (HHS) in collaboration with other federal officials enumerated in the 

Act, to “formally establish and enhance the efforts of the Interagency Coordinating Committee for 

Preventing Underage Drinking (ICCPUD).” The ICCPUD coordinates efforts to reduce underage 

drinking, guide policy and program development across the federal government, and serve as a 

resource for creating and implementing the Comprehensive Plan for Preventing Underage Drinking. 

In 2006, SAMHSA assumed leadership as the HHS Secretary’s designee. 

The STOP Act calls for data and information on the enforcement of drinking laws, steps to reduce 

alcohol’s availability to youth under the age of 21, research on underage drinking, and resources 

for local community efforts. Three areas of support for The STOP Act also calls for four annual 

reports to Congress, which are developed under contract ($1M/year). A report on the prevention 

and reduction of underage drinking. A report on state performance and best practices for the 

prevention and reduction of underage drinking and a report series on state underage drinking 

prevention and enforcement activities. 

A report on the evaluation of the adult oriented national media campaign to prevent underage 

drinking that includes the production, broadcasting, and effectiveness of the campaign – also known 

 47 U.S. Department of Health and Human Services. (December, 2018). Report to Congress on the Prevention and 

Reduction of Underage Drinking, Rockville, MD: Substance Abuse and Mental Health Services Administration 

Retrieved from www.stopalcoholabuse.gov. (National Survey on Drug Use and Health [NSDUH]; Center for 

Behavioral Health Statistics and Quality [CBHSQ], 2017c)
163

as “Talk They Hear You.” The community-based coalition enhancement grant program provides 

up to $50,000 per year over four years to current or former grantees under the Drug-Free 

Communities Act of 1997 to prevent and reduce alcohol use among youth under the age of 21. The 

STOP Act grant program enables organizations to strengthen collaboration and coordination among 

stakeholders to achieve a reduction in underage drinking in their communities. 

FY 2016 data showed that 82 percent of coalitions report at least 5 percent improvement in the 30-

day use of alcohol in at least two grades. The national media campaign to prevent underage

drinking, —“Talk. They Hear You.” (TTHY) responds to directives set forth in Section 2(d) of the 

STOP Act, to produce and oversee an adult-oriented national media campaign to provide parents 

and caregivers of youth under the age of 21 with information and resources to discuss the issue of 

alcohol with their children. The ICCPUD will continue to guide the development process of the 

national media campaign.

In FY 2017, SAMHSA provided funding for 81 STOP Act grant continuations and 17 new grants. 

In FY 2018, SAMHSA provided funding for 98 STOP Act continuation grants. SAMHSA provided

funding for 97 continuation grants and 22 new grants in FY 2019. In FY 2020, SAMHSA plans to 

support 39 STOP Act grant continuations and 79 new grants.

Program Evaluation

The “Talk. They Hear You.” (TTHY) earned media campaign48 has yielded more than a $9 to $1 

return on investment. The campaign costs average less than $1 million a year or $9,108,324 over 

10 years. More than 40 print and 28 video products have been produced. Earned media outreach 

efforts have generated an estimated $94 million in earned media placements on major networks and 

affiliates—with TV, print, and radio public service announcements having collectively garnered 

impressions in all 50 states and in more than 300 cities. Case study results show that the TTHY 

campaign had a significant positive effect on parental confidence in being able to make a difference 

in their child’s decision about alcohol consumption, and three other attitudinal categories – concern, 

importance, and intention. The campaign also increased the proportion of parents who had a 

conversation with their child about underage drinking. The campaign increased student disapproval 

of daily drinking and binge drinking post-intervention; and student perception of binge drinking 

being a health risk. 

 48 “Definition of earned media: Earned media, also referred to as media relations, word-of-mouth, PR, or publicity, is 

an unpaid brand mention or recognition such as a news article, published interview, or online review by a third party. 

In addition, earned media can also refer to a byline or article written by someone associated with the brand that is 

published by a third party.” (Top Rank Marketing, n.d.). 
164

Funding History

Fiscal Year Amount

FY 2017 $7,000,000

FY 2018 $7,000,000

FY 2019 $8,000,000

FY 2020 $9,000,000

FY 2021 $9,000,000

Budget Request 

The FY 2021 President’s Budget is $9.0 million, level with the FY 2020 Enacted. In FY 2021, 

SAMHSA will support 101 STOP Act grant continuations and 17 new grants.
165

Outputs and Outcomes Table

Program: Sober Truth on Preventing Underage Drinking (STOP Act)

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

3.3.01 Percent of coalitions that report at 

least 5% improvement in the past 30-day 

use of alcohol in at least two grades 

(Outcome)

FY 2017: 57.7 %

Target: 62 %

(Target Not Met)

57.7 % 57.7 % Maintain

3.3.02 Percent of coalitions that report 

improvement in youth perception of risk 

from alcohol in at least two grades 

(Outcome)

FY 2017: 75 %

Target: 70 %

(Target Exceeded)

75 % 75 % Maintain
166

Center for the Application of Prevention Technologies

(Dollars in thousands)

Programs of Regional & National Significance

FY 2019

Final

FY 2020

Enacted

FY 2021

President's

Budget

FY 2021

+/-

FY 2020

Center for the Application of Prevention Technologies...... $7,493 $7,493 $7,493 $---

Authorizing Legislation........................................................................................Section 516 of the PHS Act

FY 2021 Authorization....................................................................................................................$211,148,000

Allocation Method................................................................................................................................... Contracts

Eligible Entities....................................................................................................Domestic and Public Entities

Program Description and Accomplishments

In 2019, Center for the Application of Prevention Technologies (CAPT) changed how it delivered 

services and began providing science-based training and technical assistance through Prevention 

Technology Transfer Centers (PTTC) cooperative agreements. SAMHSA leadership established 

the PTTC the previous year to expand and improve implementation and delivery of effective 

substance abuse prevention interventions, and provide training and technical assistance 

services to the substance abuse prevention field. 

The PTTC does this by developing and disseminating tools and strategies needed to improve 

the quality of substance abuse prevention efforts; providing intensive technical assistance and 

learning resources to prevention professionals in order to improve their understanding of 

prevention science, epidemiological data, and implementation of evidence-based and 

promising practices; and, developing tools and resources to engage the next generation of 

prevention professionals. 

Program Evaluation

The two-year evaluation for this program begins on September 30, 2019. To date, the PTTC has 

delivered over 170 events and provided training/technical assistance to over 2,800 participants. 

Current program accomplishments include the following: 

The Mid-America PTTC has developed a partnership with the National Alliance for Drug 

Endangered Children (DEC) & Kansas Alliance for Drug Endangered Children to offer the Core 

DEC Awareness and DEC Approach trainings.

The Mountain Plains PTTC is in the process of creating an infographic for a recent study regarding 

the outcomes for people with severe Substance Use Disorders (SUD) and the correlation between 

oral health care. Treatment combined with oral care does have positive outcomes such as longer 

stay in treatment, jobs, and prevention of other diseases and relapse prevention. Improvement in 

SUD treatment outcomes at discharge suggests that complementary comprehensive oral health care 

improves SUD therapeutic results in patients with SUDs. Integrated comprehensive oral health 

care of major dental problems significantly improves treatment of outcomes in patients whose 

disorders are particularly difficult to manage, such as patients with SUDs.

The National Hispanic and Latino PTTC sponsored a successful webinar on Vaping 101: and Latino 

Youth: Devices, risks, prevention efforts, and solutions. This webinar had 440 unique viewers and 
167

provided an overview of youth vaping from what the devices look like, to why vaping is a concern 

with a specific focus on Latino youth. The webinar covered risks of youth vaping e-juice with 

flavorings, nicotine, and high potency THC concentrates and the prevalence and trends among 

Latino youth. The webinar concluded with a discussion of prevention opportunities for parents, 

professionals, and policymakers. 

Funding History

Fiscal Year Amount

FY 2017 $7,493,000

FY 2018 $7,493,000

FY 2019 $7,493,000

FY 2020 $7,493,000

FY 2021 $7,493,000

Budget Request 

The FY 2021 President’s Budget is $7.5 million, level with the FY 2020 Enacted. Prevention T/TA 

services are being conducted by the PTTCs.

 
168

Outputs and Outcomes Table

Program: Center for the Application of Prevention Technologies (CAPT)

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

1.4.14 Number of people trained 

(Output)

FY 2019: Result Expected 

December 31, 2019

Target: Set Baseline

(Pending)

Maintain 

Baseline

Maintain 

Baseline

Maintain

1.4.15 Percentage using 

information from training to 

change their practice. (Outcome)

FY 2019: Result Expected

December 31, 2019

Target: Set Baseline

(Pending)

Maintain 

Baseline

Maintain 

Baseline

Maintain
169

Science and Service Program Coordination

(Dollars in thousands)

Programs of Regional & National Significance

FY 2019

Final

FY 2020

Enacted

FY 2021

President's

Budget

FY 2021

+/-

FY 2020

Science and Service Program Coordination........................... $4,072 $4,072 $4,072 $---

Authorizing Legislation........................................................................................Section 516 of the PHS Act

FY 2021 Authorization....................................................................................................................$211,148,000

Allocation Method................................................................................................................................... Contracts

Eligible Entities....................................................................................................Domestic and Public Entities

Program Description and Accomplishments

SAMHSA has made prevention of underage drinking a priority because of its potential impact on 

the health and well-being of young people and their communities. Over the past decade, there has 

been a steady decline of drinking by adolescents and young adults. Trend data report similar 

declines in underage binge and heavy drinking. In 2017, 140.5 million Americans aged 12 or older 

reported current use of alcohol, 66.6 million reported binge drinking and 16.7 million reported 

heavy drinking.49 

The Science and Service Program Coordination program funds the provision of technical assistance 

and training to states, tribes, communities, and grantees around substance abuse prevention. 

Specifically, the program supports the Tribal Training and Technical Assistance Center and the 

Underage Drinking Prevention Education Initiatives (UADPEI). 

The Tribal Training and Technical Assistance Center is an innovative training and technical 

assistance project that helps tribal communities facilitate the development and implementation of 

comprehensive and collaborative community-based prevention plans to reduce violence, bullying, 

substance abuse, and suicide among American Indian/Alaska Native (AI/AN) youth, in support of 

the HHS Tribal Health and Well-Being Coordination. These plans mobilize tribal communities’ 

existing social and educational resources to meet their goals. 

The UADPEI efforts engage parents and other caregivers, schools, communities, all levels of 

government, all social systems that interface with youth, and youth themselves in a coordinated 

national effort to prevent and reduce underage drinking and its consequences. The UADPEI heavily 

promotes the adoption of evidence-based policies, programs, and practices by developing materials, 

resources, and other engagement tools to strengthen community-based prevention efforts. The 

initiative collaborates with other federal agencies on underage drinking prevention strategy 

implementation through ICCPUD.

The initiative engages families, youth, and youth-serving organizations in programs such as 

SAMHSA’s Communities Talk: Town Hall Meetings to Prevent Underage Drinking. 

 49 Substance Abuse and Mental Health Services Administration. (2018). Key substance use and mental health indicators 

in the United States: Results from the 2017 National Survey on Drug Use and Health (HHS Publication No. SMA 18-

5068, NSDUH Series H-53). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and 

Mental Health Services Administration. Retrieved from http://www.samhsa.gov/data.
170

In FY 2016, the last year Communities Talk events took place, community-based organizations 

registered to host 1,500 events. Event locations included all 50 states, the District of Columbia, 

and three territories. An estimated 300,000 people participated in events, either in person or 

virtually. SAMHSA garnered 1.9 million social media impressions through the #Communities Talk 

and reached an estimated 2.3 million people through traditional media promoting Communities 

Talk. SAMHSA responded to 3,000 requests for capacity development in planning, promoting, 

hosting, and evaluating events. Communities Talk events are funded on a biannual basis. SAMHSA 

will continue to fund two contracts to support these activities.

Program Evaluation

The next round of evaluations for Communities Talk is currently underway for the period of 2019-

2020. The Underage Drinking Prevention Education Initiative’s (UADPEI) Communities Talk: 

Town Hall Meetings to Prevent Underage Drinking (Communities Talk) initiative is in the final 

stages of its stipend distribution for prevention-focused events. In 2019 the UADPEI will be close 

to reaching its goal of 1,000 organizations hosting underage drinking prevention events. Events are 

in all 50 states, the District of Colombia, and 4 U.S. Territories. More than 140 institutions of higher 

education are also participating in the 2019 Communities Talk cycle. UADPEI promotes the 

adoption of evidence-based policies, programs, and practices by developing materials, resources, 

and other engagement tools to strengthen community-based prevention efforts. UADPEI’s 

Communities Talk initiative builds capacity in underage drinking prevention among institutes of 

higher education and community-based organizations. Each month UADPEI produces an e-alert 

for Communities Talk listserv subscribers that contains information for hosting a successful 

Communities Talk event.

Tribal Training and Technical Assistance Contract (TTA)

In FY 2017, the Tribal TTA Center team collected data on 20 Broad training events that served a 

total of 583 participants representing 93 AI/AN communities over 31 days. There were 20 Focused 

training events that served a total of 992 participants over representing 36 AI/AN communities for 

13 days and 5 events. One virtual Broad TA event served a total of 27 participants. Intensive 

virtual TA served 96 participants through 9 events and 99.2 virtual TA days.

Data collected throughout FY 2017 indicates that, overall, questionnaire respondents felt the 

trainings/TA improved their and their organization’s capacity to do prevention work.
171

Funding History

Fiscal Year Amount

FY 2017 $4,072,000

FY 2018 $4,072,000

FY 2019 $4,072,000

FY 2020 $4,072,000

FY 2021 $4,072,000

Budget Request

The FY 2021 President’s Budget is $4.1 million, level with the FY 2020 Enacted. This funding 

will support SAMHSA’s substance abuse prevention efforts and include a focus on preventing 

underage drinking and providing technical assistance and training to American Indians/Alaska 

Native communities. 
172

Outputs and Outcomes Table

Program: Prevention - Science and Service Activities

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

2.3.80 Number of organizations or 

communities that demonstrate improved 

readiness to change their systems (Output)

FY 2019: 5.0 organizations

Target: 5.0 organizations

(Baseline)

5.0 organizations 5.0 organizations Maintain
173

Tribal Behavioral Health Grants

(Dollars in thousands)

Programs of Regional & National Significance

FY 2019

Final

FY 2020

Enacted

FY 2021

President's

Budget

FY 2021

+/-

FY 2020

Tribal Behavioral Health Grants........................................ $20,000 $20,000 $20,000 $---

Authorizing Legislation........................................................................................Section 516 of the PHS Act

FY 2021 Authorization....................................................................................................................$211,148,000

Allocation Method......................................................................................................................Grants/Contracts

Eligible Entities...............................................................................................................................................Tribes

Program Description and Accomplishments

Suicide is the second leading cause of death among American Indian/Alaska Native (AI/AN) youth 

ages eight to 24 years.50 Further, AI/AN high school students report higher rates of suicidal 

behaviors than the general population of U.S. high school students.51 These behaviors include 

serious thoughts of suicide, suicide plans, suicide attempts, and medical attention for a suicide 

attempt. However, the risk of suicide is not the same in all AI/AN youth demographic groups. For 

instance, AI/AN youth raised in urban settings have a smaller risk of having thoughts of suicide 

than AI/AN youth raised on tribal reservations (21 percent and 33 percent, respectively).52

Consistent with the goals of the Tribal Behavioral Health Agenda, the Tribal Behavioral Health 

Grant (TBHG) program addresses the high incidence of substance use and suicide among AI/AN 

populations. Starting in FY 2014, this program supports tribal entities with the highest rates of 

suicide by providing effective and promising strategies that address substance abuse, trauma, and 

suicide and by promoting the mental health of AI/AN young people.

The first cohort of TBHG grants to 20 tribes or tribal organizations with high rates of suicide. These 

five-year grants help grantees develop and implement a plan that addresses suicide and substance 

abuse, thereby promoting mental health among tribal youth. In addition, SAMHSA’s Tribal 

Training and Technical Assistance Center (http://www.samhsa.gov/tribal-ttac) provides training 

and education to AI/AN grantees and organizations serving AI/AN populations to support their 

ability to achieve their goals. 

This initiative takes a comprehensive, culturally appropriate approach to help improve the lives of 

and opportunities for AI/AN youth. In addition to the Department of Health and Human Services, 

multiple agencies, including the Departments of Interior, Education, Housing and Urban 

Development, Agriculture, Labor, and Justice, are working collaboratively with tribes to address 

issues facing AI/AN youth. 

 50 Centers for Disease Control and Prevention. Fatal injury data, 2010. Web-based Injury Statistics Query and Reporting 

System. Available at www.cdc.gov/injury/wisqars/fatal.html. Accessed May 27, 2014.

51 Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance System (YRBSS). Available at 

http://www.cdc.gov/healthyyouth/yrbs/index.htm. Accessed May 27, 2014. 

52 Freedenthal, S. & Stiffman, A. R. (2004). Suicidal Behavior in Urban American Indian Adolescents: A Comparison 

with Reservation Youth in a Southwestern State. Suicide and Life-Threatening Behavior, 34(2), 160-171.
174

In FY 2016, SAMHSA expand activities through the braided TBHG ($15.0 million in the Substance 

Abuse Prevention appropriation and $15.0 million in Mental Health appropriation) to allow tribes 

the flexibility to implement community-based strategies to address trauma, prevent substance 

abuse, and promote mental health and resiliency among youth in tribal communities. The additional 

FY 2016 funding expanded these activities to approximately 90 tribes and tribal entities. With the 

expansion of the TBHG program, SAMHSA’s goal is to reduce substance use and the incidence of 

suicide attempts among AI/AN youth and to address behavioral health conditions that affect 

learning in the Bureau of Indian Education-funded schools. 

Program Evaluation

In FY 2018, grantees have screened 103,000 individuals for mental health and suicide concerns; 

784,939 individuals were exposed to mental health and suicide awareness messaging, and 1,127 

organizations specific mental health related practices and activities that aligned with program goals.

In FY 2018, SAMHSA supported 80 grant continuations, 46 new grants, and technical assistance 

activities. In FY 2019, SAMHSA supported 109 grant continuations, 26 new grants, and technical 

assistance activities. In FY 2020, SAMHSA will support 120 grant continuations, 14 new grants, 

and technical assistance activities.

Funding History

Fiscal Year Amount

FY 2017 $14,450,000

FY 2018 $15,000,000

FY 2019 $20,000,000

FY 2020 $20,000,000

FY 2021 $20,000,000

Budget Request

The FY 2021 President’s Budget is $20.0 million, level with the FY 2020 Enacted. This request, 

along with $20.0 million in the Center of Mental Health Services will continue to support 

approximately 179 grants that promote mental health and prevent substance use activities for highrisk AI/AN youth and their families.

As a braided activity, SAMHSA will track separately any amounts spent or awarded under Tribal 

Behavioral Health Grants through the distinct appropriations and ensure that funds are used for 

purposes consistent with legislative direction and intent of these appropriations.
175

Outputs and Outcomes Table

Program: Tribal Behavioral Health Grants53

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

2.4.12 Percentage of youth age 10 -

24 who received mental health or 

related services after screening, 

referral or attempt (Output)

FY 2019: 43

Target: 56

(Target Not Met but Improved)

43 43 Maintain

2.4.13 Number of 

programs/organizations that 

implemented specific mental-health 

related practices/activities as a result 

of the grant (Outcome)

FY 2019: 7,219

Target: 5,670

(Target Exceeded)

7,219 7,219 Maintain

 53 This is a combined total performance for CMHS and CSAP.
176

Minority Fellowship Program

(Dollars in thousands)

Programs of Regional & National Significance

FY 2019

Final

FY 2020

Enacted

FY 2021

President's

Budget

FY 2021

+/-

FY 2020

Minority Fellowship Program................................................ $321 $321 $321 $---

Authorizing Legislation........................................................................................Section 597 of the PHS Act

FY 2021 Authorization......................................................................................................................$12,669,000

Allocation Method......................................................................................................................Grants/Contracts

Eligible Entities.......Organizations that represent individuals obtaining post baccalaureate training

(including for master’s and doctoral degrees) for mental and substance use disorder treatment

professionals, including in the fields of psychiatry, nursing, social work, psychology, marriage 

and family therapy, mental health counseling, and substance use disorder and addiction 

counseling

Program Description and Accomplishments

SAMHSA’s Minority Fellowship Program (MFP) increases behavioral health practitioners’ 

knowledge of issues related to prevention, treatment, and recovery support for mental illness and 

drug/alcohol addiction among racial and ethnic minority populations. The program provides 

stipends to increase the number of culturally competent behavioral health professionals who teach, 

administer, conduct services research, and provide direct mental illness or substance use disorder 

treatment services for minority populations that are underserved. Since its start in 1973, the 

program has helped to enhance services for racial and ethnic minority communities through

specialized training of mental health professionals in psychiatry, nursing, social work, and 

psychology. In 2006, the program expanded to include marriage and family therapists and later 

added professional counselors. Professional guilds receive competitively awarded grants, and then 

competitively award the stipends to post-graduate students pursuing a degree in that professional 

field. In FY 2018 and 2019, SAMHSA funded seven continuation grants. 
177

Funding History

Fiscal Year Amount

FY 2017 $71,000

FY 2018 $71,000

FY 2019 $321,000

FY 2020 $321,000

FY 2021 $321,000

Budget Request

The FY 2021 President’s Budget is $0.321 million, level with the FY 2020 Enacted. Funding for 

this program will continue to support prevention related grants.
178

SAMHSA/Substance Abuse Prevention

PRNS Mechanism Table Summary

(Dollars in thousands)

Programs of Regional & National Significance

FY 2019

Final

FY 2020

Enacted

FY 2021

President's

Budget

Grants

Continuations............................................. 464 142,280 468 129,479 365 56,417

New/Competing......................................... 168 38,164 211 51,957 89 16,550

Subtotal.................................................. 632 180,444 679 181,198 454 72,712

Contracts

Continuations............................................. 14 23,764 12 23,883 9 15,327

New............................................................ --- 1,261 1 1,388 35 8,945

Subtotal.................................................. 14 25,025 13 25,271 44 24,273

Total, Substance Abuse Prevention PRNS 646 $205,469 692 $206,469 498 $96,985
179

SAMHSA/Substance Abuse Prevention

PRNS Mechanism Table by Program, Project, and Activity

(Dollars in thousands)

Programs of Regional & National Significance

FY 2019

Final

FY 2020

Enacted

FY 2021

President's

Budget

Capacity:

Strategic Prevention Framework

Grants

Continuations....................................................................... 87 $78,450 170 $82,294 --- ---

New/Competing.................................................................... 114 31,592 20 27,781 25 $9,426

Supplements......................................................................... --- --- ---

Subtotal 201 110,042 190 110,076 25 9,426

Contracts

Continuations....................................................................... 5 9,442 3 9,408 --- 574

New........................................................................................ --- --- ---

Subtotal 5 9,442 3 9,408 --- 574

Total, Strategic Prevention Framework 206 119,484 193 119,484 25 10,000

Federal Drug-Free Workplace 

Contracts

Continuations....................................................................... 2 4,009 3 4,322 3 4,353

New........................................................................................ --- 885 --- 572 --- 541

Subtotal............................................................................. 2 4,894 3 4,894 3 4,894

Total, Federal Drug-Free Workplace 2 4,894 3 4,894 3 4,894

Minority AIDS

Grants

Continuations....................................................................... 141 37,673 94 22,445 144 31,884

New/Competing.................................................................... 6 1,195 82 16,691 --- ---

Subtotal............................................................................. 147 38,868 176 39,136 144 31,884

Contracts

Continuations....................................................................... --- 2,101 --- 2,069 --- 2,366

New........................................................................................ --- 236 --- --- 34 6,955

Subtotal............................................................................. --- 2,337 --- 2,069 34 9,321

Total, Minority AIDS 147 41,205 176 41,205 178 41,205

Sober Truth on Preventing Underage Drinking Act

Grants

Continuations....................................................................... 97 4,537 39 1,833 101 4,781

New/Competing.................................................................... 22 1,075 94 4,746 34 1,715

Subtotal............................................................................. 119 5,613 133 6,578 135 6,496

Contracts

Continuations....................................................................... 2 2,387 1 1,439 1 1,517

New........................................................................................ --- --- 1 983 1 987

Subtotal............................................................................. 2 2,387 2 2,422 2 2,504

Total, Sober Truth on Preventing Underage Drinking Act 121 8,000 135 9,000 137 9,000
180

SAMHSA/Substance Abuse Prevention

PRNS Mechanism Table by Program, Project, and Activity

(Dollars in thousands)

Programs of Regional & National Significance

FY 2019

Final

FY 2020

Enacted

FY 2021

President's

Budget

Tribal Behavioral Health Grants

Grants

Continuations....................................................................... 119 13,484 145 15,109 100 12,368

New/Competing.................................................................... 26 4,302 15 2,500 30 5,174

Subtotal............................................................................. 145 17,786 160 17,610 130 17,542

Contracts

Continuations....................................................................... 1 2,214 1 2,390 1 2,458

New/Competing.................................................................... --- --- --- --- --- ---

Subtotal............................................................................. 1 2,214 1 2,390 1 2,458

 Total, Tribal Behavioral Health Grants 146 20,000 161 20,000 131 20,000

Science and Service:

Center for the Application of Prevention Technologies

Grants

Continuations....................................................................... 13 7,493 13 7,493 13 7,063

New/Competing.................................................................... --- --- --- ---

Subtotal............................................................................. 13 7,493 13 7,493 13 7,063

Contracts

Continuations....................................................................... --- --- --- 430

New/Competing.................................................................... --- --- --- ---

Subtotal............................................................................. --- --- --- --- --- 430

Total, Center for the Application of Prevention 

Technologies 13 7,493 13 7,493 13 7,493

SAP Minority Fellowship Program

Grants

Continuations....................................................................... 7 272 7 66 7 66

New/Competing.................................................................... --- --- --- 239 --- 235

Subtotal............................................................................. 7 272 7 305 7 301

Contracts

Continuations....................................................................... --- 16 --- 16 --- 20

New/Competing.................................................................... --- 32 --- --- --- ---

Subtotal............................................................................. --- 49 --- 16 --- 20

Total, SAP Minority Fellowship Program 7 321 7 321 7 321
181

SAMHSA/Substance Abuse Prevention

PRNS Mechanism Table by Program, Project, and Activity

(Dollars in thousands)

Programs of Regional & National Significance

FY 2019

Final

FY 2020

Enacted

FY 2021

President's

Budget

Science & Service Program Coordination

Grants

Continuations........................................................ --- 369 --- --- --- ---

New/Competing.................................................... --- --- --- --- --- ---

Subtotal............................................................. --- 369 --- --- --- ---

Contracts

Continuations........................................................ 4 3,595 4 4,072 4 3,610

New....................................................................... --- 108 --- --- 462

Subtotal............................................................. 4 3,703 4 4,072 4 4,072

Total, Science & Service Program Coordination 4 4,072 4 4,072 4 4,072

Subtotal, Science and Service 24 11,886 24 11,886 24 11,886

Total, Substance Abuse Prevention 646 $205,469 692 $206,469 498 $96,985
182

Grant Awards Table

(Whole dollars)

FY 2019

Final

FY 2020

Enacted

FY 2021

President's

Budget

Number of Awards 632 679 454

Average Award $285,512 $266,861 $160,159

Range of Awards $50,000 - $2,300,000 $50,000 - $2,300,000 $50,000 - $2,300,001
183

SAMHSA

Substance Abuse Treatment

Table of Contents

1. Substance Abuse Treatment Appropriation.......................................................................... 183

2. Programs of Regional and National Significance (PRNS)................................................... 184

a) Opioid Treatment Programs/Regulatory Activities....................................................... 185

b) Screening, Brief Intervention and Referral to Treatment.............................................. 188

c) Targeted Capacity Expansion-General.......................................................................... 192

d) Pregnant and Postpartum Women ................................................................................. 198

e) Recovery Community Services Program ...................................................................... 202

f) Children and Families ................................................................................................... 205

g) Treatment Systems for Homeless.................................................................................. 210

h) Minority AIDS .............................................................................................................. 214

i) Criminal Justice Activities ............................................................................................ 216

j) Building Communities of Recovery.............................................................................. 224

k) Minority Fellowship Program ....................................................................................... 227

l) Addiction Technology Transfer Centers....................................................................... 229

m) Improving Access to Overdose Treatment.................................................................... 232

n) First Responder Training for Opioid Overdose Reversal Drug .................................... 235

o) Grants to Prevent Prescription Drug/Opioid Overdose Related Deaths........................ 238

p) Grants to Develop Curricular for DATA Act Waivers ................................................. 241

q) Peer Support Technical Assistance Center....................................................242

r) Emergency Department Alternatives to Opioids.............................................244

s) Treatment, Recovery, and Workforce Support................................................246

3. PRNS Mechanism Table Summary ...................................................................................... 248

4. PRNS Mechanism Table by Program, Project, and Activity................................................ 249

5. Grant Award Table ............................................................................................................... 255

6. State Opioid Response Grants .............................................................................................. 256

7. Substance Abuse Prevention and Treatment Block Grant.................................................... 260
184

Substance Abuse Treatment Appropriation

(Dollars in thousands)

FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

FY 2021 

President's 

Budget 

+/- 

FY 2020 

Enacted

Programs of Regional and National Significance....................... $458,531 $479,677 $364,677 -$115,000

PHS Evaluation Funds (non-add).......................................... 2,000 2,000 --- -2,000

State Opioid Response Grants...................................................... 1,500,000 1,500,000 1,585,000 85,000

Set-Aside for Tribes (non-add)................................................ --- --- 50,000 50,000

Substance Abuse Prevention and Treatment Block Grant....... 1,858,079 1,858,079 1,858,079 ---

 Budget Authority (non-add)..................................................... 1,778,879 1,778,879 1,778,879 ---

PHS Evaluation Funds (non-add).......................................... 79,200 79,200 79,200 ---

Total, Substance Abuse 

Treatment............................................. $3,816,610 $3,837,756 $3,807,756 -$30,000

The Substance Abuse Treatment FY 2021 President’s Budget is $3.8 billion, a decrease of $30.0 

million from the FY 2020 Enacted. The request includes $3.7 billion in Budget Authority and $79.2 

million in Public Health Service (PHS) Evaluation funds.
185

Programs of Regional and National Significance (PRNS)

Substance Abuse Treatment Appropriation

(Dollars in thousands)

FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

FY 2021 

President's 

Budget 

+/- 

FY 2020 

Programs of Regional and National Significance Enacted

Capacity:

Opioid Treatment Programs/Regulatory Activities............................ $8,724 $8,724 $8,724 ---

Screening, Brief Intervention and Referral to Treatment................... 27,854 30,000 --- -30,000

Budget Authority (non-add)............................................................ 25,854 28,000 --- -28,002

PHS Evaluation Funds (non-add).................................................. 2,000 2,000 --- -2,000

Targeted Capacity Expansion-General............................................... 100,192 100,192 11,192 -89,000

Other Targeted Capacity Expansion.............................................. 11,192 11,192 11,192 ---

MAT for Prescription Drug and Opioid Addiction (non-add)....... 89,000 89,000 --- -89,000

Pregnant and Postpartum Women...................................................... 29,931 31,931 31,931 ---

Recovery Community Services Program........................................... 2,434 2,434 2,434 ---

Improving Access to Overdose Treatment......................................... 1,000 1,000 1,000 ---

Building Communities of Recovery................................................... 6,000 8,000 8,000 ---

Children and Families........................................................................ 29,605 29,605 29,605 ---

Treatment Systems for Homeless....................................................... 36,386 36,386 36,386 ---

Minority AIDS.................................................................................... 65,570 65,570 65,570 ---

Criminal Justice Activities.................................................................. 89,000 89,000 89,000 ---

Other Criminal Justice Activities (non-add)................................. 19,000 19,000 19,000 ---

Drug Court Activities (non-add)..................................................... 70,000 70,000 70,000 ---

Grants to Prevent Prescription Drug/Opioid Overdose-Related Deaths 12,000 12,000 12,000 ---

Peer Support TA Center...................................................................... --- 1,000 1,000 ---

Treatment, Recovery, and Workforce Support.................................... --- 4,000 4,000 ---

Emergency Department Alternatives to Opioids.................................. --- 5,000 5,000 ---

Grants to Develop Curricula for DATA Act Waivers........................... --- --- 4,000 4,000

First Responder Training (CARA)......................................................... 36,000 41,000 41,000 ---

First Responder Training (non-add).................................................. 18,000 18,000 18,000 ---

Rural Set-Aside (non-add).................................................................. 18,000 23,000 23,000 ---

Subtotal, Capacity 444.696 465,842 350,842 -115,000

Science and Service:

SAT Minority Fellowship Programs...................................................... 4,789 4,789 4,789 ---

Addiction Technology Transfer Centers............................................... 9,046 9,046 9,046 ---

Subtotal, Science and Service 13,835 13,835 13,835 ---

Total, PRNS $458.531 $479,677 $364,677 -$115,000

Authorizing Legislation .............................................Section 509 of the Public Health Service Act

FY 2021 Authorization ................................................................................................$333,806,000

Allocation Method ....................................Competitive Grants/Cooperative Agreements/Contracts 

Eligible EntitiesStates, local governments, Communities, Federal Recognized, American 

Indian/Alaska Native tribes or tribal organization, Indian Health Service-operated and contracted

health facilities and programs, public or private nonprofit entities
186

Opioid Treatment Programs/Regulatory Activities

(Dollars in thousands) 

Programs of Regional & National Significance

FY 2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 2020

Opioid Treatment Programs/Regulatory Activities.... $8,724 $8,724 $8,724 $---

Authorizing Legislation ............................................Section 509 of the Public Health Service Act

FY 2021 Authorization................................................................................................ $333,806,000

Allocation Method....................................Competitive Grants/Contracts/Cooperative Agreements

Eligible Entities..............................................................American Society of Addiction Medicine,

American Academy of Addiction Psychiatry, American Medical Association,

American Osteopathic Association, American Psychiatric Association,

American Dental Association

Domestic Medical Schools, Physician Assistant Schools, and Schools of Nursing

Program Description and Accomplishments

The misuse of prescription opioid pain relievers and illicit opioids, such as heroin, is causing 

suffering, sickness, overdose, and death in the United States at epidemic levels.54 Communities 

across the nation also face the risk that individuals who inject opioids will contract and spread 

Human Immunodeficiency Virus (HIV) and hepatitis C.55 One of the underlying causes of these 

problems is opioid abuse.56,57 

With increasing incidence of opioid abuse, there is a corresponding increase in admissions for 

treatment of opioid abuse.58 Medication-assisted treatment (MAT) refers to the use of the Food and 

Drug Administration (FDA) approved pharmacotherapies (i.e., buprenorphine products, 

methadone, and naltrexone products) in combination with evidence-based psychosocial 

interventions for treatment of opioid use disorders. MAT is a safe and effective strategy for 

 54 U.S. Department of Health and Human Services. Addressing prescription drug abuse in the United States: current 

activities and future opportunities. 2013. Retrieved from 

www.cdc.gov/drugoverdose/pdf/hhs_prescription_drug_abuse_report_09.2013.pdf

55 Substance Abuse and Mental Health Services Administration. Associations of nonmedical pain reliever use and 

initiation of heroin use in the United States. 2013. Retrieved from 

https://www.samhsa.gov/data/sites/default/files/DR006/DR006/nonmedical-pain-reliever-use-2013.htm 56 Johnson EM, Lanier WA, Merrill RM, et al. Unintentional prescription opioid-related overdose deaths: description 

of decedents by next of kin or best contact, Utah, 2008-2009. J Gen Intern Med. 2013;28(4): 522-9. 57 Bohnert AS, Valenstein M, Bair MJ, et al. Association between opioid prescribing patterns and opioid overdoserelated deaths. JAMA. 2011;305(13):1315-1321. doi:10.1001/jama.2011.370. 58 Paulozzi LJ, Jones CM, Mack KA, Rudd RA. Vital signs: overdoses of prescription opioid pain relievers – United 

States, 1999-2008. MMWR Morb Mortal Wkly Rep. 2011;60(43): 1487-92.
187

decreasing the frequency and quantity of opioid use and reducing the risk of overdose and death.

Approximately one million Americans need, but do not access, treatment for an opioid addiction.59

OTPs are the only means of providing medication-assisted treatment (MAT) with methadone. 

Buprenorphine can be prescribed in an office setting by physicians who have received a waiver 

under the Drug Addiction Treatment Act of 2000 (DATA 2000) provision of the Controlled 

Substances Act. Most physicians with a waiver to prescribe buprenorphine do not treat the 

maximum allowable number of patients. 

In November 2016, the implementation of Section 303 of the Comprehensive Addiction and 

Recovery Act (CARA) enabled the Department of Health and Human Services (HHS) to announce 

that nurse practitioners (NPs) and physician assistants (PAs) could immediately begin taking the 24 

hours of required training to prescribe buprenorphine for the treatment of opioid addiction. CARA 

expanded prescribing privileges to NPs and PAs for five years (until October 1, 2021). With the 

passage of the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment 

for Patients and Communities (SUPPORT) Act in October 2018, the five-year limit on prescribing 

privileges for NPs and PAs was removed. Additionally, the SUPPORT Act expanded prescribing 

privileges to Clinical Nurse Specialists (CNSs), Certified Registered Nurse Anesthetists (CRNSs), 

and Certified Nurse Midwives (CNMs) until October 1, 2023.

SAMHSA is responsible for regulating and certifying as of September, 2019, approximately 1,700

OTPs to use opioid agonist treatment medications and processing DATA waivers for qualifying 

practitioners and physician assistants, who wish to treat opioid use disorder with buprenorphine. 

SAMHSA reviews new and renewal applications for OTPs and oversees their accreditation process. 

OTPs are required to be accredited as a condition of certification. SAMHSA’s regulation of OTPs 

plays a critical role in expanding access and maintaining quality. Accrediting organizations must 

be approved by SAMHSA to fulfill this function and this approval must be renewed every five 

years. SAMHSA monitors the accrediting bodies for quality assurance and improvement by 

making 25 to 30 site visits to programs that received accreditation review with in that year;

additionally, SAMHSA can conduct unannounced OTP site visits to investigate complaints and 

determine compliance with federal regulations in 42 CFR Part 8. 

SAMHSA implements DATA 2000 in coordination with the Drug Enforcement Administration 

(DEA). This includes approving waivers for qualified practitioners to provide medication-assisted 

treatment in office-based settings. More than 57,000 practitioners have been granted waivers since 

2001. Waiver processing is conducted under a contract entitled DATA Waiver Processing and 

Support Project. As of July 27, 2019, SAMHSA has certified 39,791 physicians to treat up to 30 

patients, 10,166 to treat up to 100 patients, and 4,984 to treat up to 275 patients.

In addition, as of July 27, 2019, SAMHSA had approved 11,945 NPs and 3,182 PAs to begin 

prescribing buprenorphine. Through a cooperative agreement and a supplement, SAMHSA 

supports the Providers’ Clinical Support System (PCSS), which provides education, training and 

clinical mentoring to primary care providers who wish to treat opioid use disorder. 

In FY 2018, SAMHSA funded 24 Provider’s Clinical Support System – Universities grants. The 

purpose of this program is to expand and/or enhance access to medication-assisted treatment (MAT) 

services through ensuring the education and training of students in the medical, physician assistant 

and nurse practitioner fields. 
188

In FY 2019, SAMHSA funded 20 new Provider’s Clinical Support System – Universities (PCSSU) grants, one new PCSS-MAT grant, 28 continuation PCSS-U awards, and two contract 

continuation awards.

In FY 2020, SAMHSA anticipates funding 49 continuation grants and two contract continuation 

awards.

Program Evaluation

The benefits of the Provider’s Clinical Support System is that it provides the necessary skills and 

education for providers while they are in school. Once the provider graduates they are able to use 

obtain their DATA 2000 Waiver and provide much needed Medication Assisted Treatment to treat 

Opioid Use Disorder and combat the Opioid Epidemic. Provider’s Clinical Support System 

Universities Grants will begin collecting performance data in December 2019, using the new 

Technology Transfer Center data collection tool. 

Funding History

Fiscal Year Amount

FY 2017 $8,724,000

FY 2018 $8,724,000

FY 2019 $8,724,000

FY 2020 $8,724,000

FY 2021 $8,724,000

Budget Request

The FY 2021 President’s Budget is $8.7 million, level with the FY 2020 Enacted level. This request

supports the Secretary’s five-prong strategy to address the opioid crisis priorities. In this program, 

this is through regulatory activities, ongoing training, certification, and technical assistance to 

provider groups and communities impacted by the opioid crisis.

 59 Jones, C. M. (2013). Heroin use and heroin use risk behaviors among nonmedical users of prescription opioid pain 

relievers, United States, 2002-2004 and 2008-2010. Drug and Alcohol Dependence, 132(1-2):95-100.
189

Screening, Brief Intervention, and Referral to Treatment

(Dollars in thousands) 

Programs of Regional & National Significance

FY 2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 2020

Screening, Brief Intervention and Referral to Treatment $27,854 $30,000 $--- -$30,000

Budget Authority (non-add)..................................... 25,854 28,000 --- -28,000

 PHS Evaluation Funds (non-add)................................ 2,000 2,000 --- -2,000

Authorizing Legislation.................................. Section 509 of the Public Health Service Act

FY 2021 Authorization........................................................................$333,806,000

Allocation Method...........................Competitive Grants/Contracts/Cooperative Agreements

Eligible Entities..............................Single State Authority and Health Departments in States

Territories, the District of Columbia,

Federally Recognized American Indian/Alaska Native Tribes or Tribal Organizations,

Domestic Public and Private Non-Profit Entities, and

Public and Private Universities Colleges

Program Description and Accomplishments

Among individuals age 12 or older, 30.5 million (11.2 percent) use illicit drugs, 66.6 million (47.4 

percent of current alcohol users) binge drink, and 16.7 million (25.1 percent of current alcohol 

users) drink heavily.60 This imposes a great cost on society by compromising individual health and 

potentially causing injury to others. The National Institute on Drug Abuse found that misuse of 

illicit drugs, tobacco and alcohol costs society $740 billion each year.61 Of the individuals who 

need treatment for substance abuse, only 10.8 percent receive treatment in a specialty treatment 

facility.62 The vast majority of those meeting criteria for having a drug/alcohol addiction have not 

been diagnosed. 

In 2003, SAMHSA started the Screening, Brief Intervention and Referral to Treatment (SBIRT) 

program, which is intended to help primary care physicians identify individuals who misuse 

substances and help them intervene early with education, brief treatment, or referral to specialty 

treatment. The program’s goal is to increase the number of individuals who receive treatment and 

reduce the rate of substance misuse. Studies have shown that this approach is effective in helping 

reduce harmful alcohol consumption.63,64,65

 60Center for Behavioral Health Statistics and Quality. (2017). Key substance use and mental health indicators in the 

United States: Results from the 2015 National Survey on Drug Use and Health (HHS Publication No. SMA 16-4984, 

NSDUH Series H-51). Retrieved from http://www.samhsa.gov/data/ 61 National Institute on Drug Abuse (2017), Trends and Statistics, http://www.drugabuse.gov/related-topics/trendsstatistics.

62 Center for Behavioral Health Statistics and Quality. (2016). Key substance use and mental health indicators in the 

United States: Results from the 2015 National Survey on Drug Use and Health (HHS Publication No. SMA 16-4984, 

NSDUH Series H-51). Retrieved from http://www.samhsa.gov/data/ 63 Bertholet, N., Daeppen, J.-B., Wietlisbach, V., Fleming, M., & Burnand, B. (2005). Reduction of alcohol 

consumption by brief alcohol intervention in primary care: systematic review and meta-analysis. Archives of Internal 

Medicine 165, 986–995. 64 Kahan, M., Wilson, L., & Becker, L. (1995). Effectiveness of physician-based interventions with problem drinkers: 

A review. Canadian Medical Association Journal, 152, 851–859. 65 Wilk, A.I., Jensen, N.M., and Havighurst, T.C. (1997). Meta-analysis of randomized control trails addressing brief 

interventions in heavy alcohol drinkers. Journal of General Medicine, 12 (5), 274-283.
190

The SBIRT program seeks to increase the use of SBIRT in medical settings by promoting wide 

dissemination and adoption of the practice across the spectrum of primary care services. To achieve 

this, SAMHSA awards state implementation grants to encourage adoption of SBIRT by healthcare 

providers in each state. SAMHSA also supports the SBIRT Student Training grant programs. 

The SBIRT program requires state grant recipients to implement the model in all primary care 

settings, as well as hospitals, trauma centers, federally qualified health centers, and other relevant 

health care settings. Recipients may use funds to screen for substance use and co-occurring mental 

illness and drug/alcohol addiction. They can support evidence-based client-centered interventions, 

such as Motivational Interviewing, brief treatment, and referral to specialty care for individuals 

exhibiting addiction symptoms.

The SBIRT training program helps train a wide range of medical providers to incorporate SBIRT 

as part of their ongoing practice. This includes physicians, nurses, counselors, social workers, 

health promotion advocates, health educators, and others. A SAMHSA-funded cross-site 

evaluation found that allied health professionals, rather than the physicians themselves, were more 

likely to implement SBIRT with their patients.66 The SBIRT Student Training and Health 

Professionals Training grant programs support SBIRT training efforts for medical students, medical 

residents, nurses, social workers, psychologists, pharmacists, dentists, and physician assistants. 

These efforts aim to develop further the primary healthcare workforce in substance abuse treatment 

and services.

Program Evaluation

SAMHSA has demonstrated the effectiveness of SBIRT and continues to disseminate SBIRT 

practices. For FY 2018, the program served over 77,000 clients. At six-month follow-up, 32

percent of clients reported that they were currently employed or attending school, an increase of 

29.5 percent from those reporting at intake; 48.9 percent reporting that they had a permanent place 

to live in the community; 40.9 percent reported abstinence from substance use, a 246.6 percent

increase from those reporting at intake; and 97.1 percent reported no past 30-day arrests, a 7.8

percent increase from those reporting at intake.

In FY 2019, SAMHSA funded eight continuation state cooperative agreements and 13 new SBIRT 

state grants to support program implementation. 

In FY 2020, SAMHSA anticipates funding 21 continuation grants.

Funding History

Fiscal Year Amount

FY 2017 $30,000,000

FY 2018 $24,700,000

FY 2019 $27,854,000

FY 2020 $30,000,000

FY 2021 ---

 66 RTI International (2009). RTI International to Evaluate Comprehensive Substance Abuse Intervention Programs for 

SAMHSA. 
191

Budget Request

The FY 2021 President’s Budget is $0.0 million, a decrease of $30.0 million from the FY 2020 

Enacted level. SBIRT grants will end in FY 2021. This successful demonstration has been taken 

up across the country and can be paid for by public and third party insurance. States are encouraged 

to incorporate support for the SBIRT program model with other funding sources. 
192

Outputs and Outcomes Table

 Program: Screening, Brief Intervention and Referral to Treatment

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

1.2.40 The number of clients served 

(Output)

FY 2019: 73,462

Target: 78,000

(Target Not Met)

73,462 Discontinued N/A

1.2.41 Percentage of clients receiving 

services who had no past month 

substance use (Outcome)

FY 2019: 35.2 %

Target: 41 %

(Target Not Met)

35.2 % Discontinued Maintain
193

Targeted Capacity Expansion-General

(Dollars in thousands)

Programs of Regional & National Significance

FY 2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 2020

Targeted Capacity Expansion-General.................................... $100,192 $100,192 $11,192 -$89,000

Other Targeted Capacity Expansion............................... 11,192 11,192 11,192 ---

MAT for Prescription Drug and Opioid Addiction (non-add) 89,000 89,000 --- -89,000

 Authorizing Legislation ......................................... Sections 509 of the Public Health Service Act

FY 2021 Authorization................................................................................................ $333,806,000

Allocation Method....................................Competitive Grants/Contracts/Cooperative Agreements

Eligible Entities....................................... Domestic Public and Private Non-Profit Entities, States,

Opioid Medication-Assisted SPF Rx Treatment Service Providers, Outpatient Substance Abuse 

Providers, Community Mental Health Centers, Federally Qualified Health Centers,

SAMHSA Certified Opioid Treatment Programs, and

Licensed Outpatient Substance Abuse Treatment Programs 

Program Description and Accomplishments

Urgent, unmet, and emerging substance abuse treatment and recovery support service capacity 

needs remain a critical issue for the nation. In an effort to assist communities in overcoming these 

barriers, SAMHSA initiated the Targeted Capacity Expansion (TCE) program. The program 

provides rapid, strategic, comprehensive, and integrated community-based responses to gaps in and 

capacity for substance abuse treatment and recovery support services. Examples of such needs 

include limited or no access to medication-assisted treatment (MAT) for opioid use disorders; lack 

of resources needed to adopt and implement health information technology (HIT) in substance 

abuse treatment settings; and short supply of trained and qualified peer recovery coaches to assist 

individuals in the recovery process.

Medication-Assisted Treatment for Prescription Drug and Opioid Addiction (MAT -PDOA)

The MAT-PDOA program addresses treatment needs of individuals who have an opioid use 

disorder (OUD) by expanding/enhancing treatment system capacity to provide accessible, effective, 

comprehensive, coordinated/integrated, and evidence-based MAT and recovery support services.

 

MAT refers to the use of the Food and Drug Administration-approved pharmacotherapies 

(i.e., buprenorphine products, methadone, and naltrexone products) in combination with 

evidence- based psychosocial interventions for treatment of OUD. MAT is a safe and effective 

strategy for decreasing the frequency and quantity of opioid misuse and reducing the risk of 

overdose and death. Recovery support services include linking patients and families to social, legal, 

housing, and other supports to improve retention in MAT to increase the probability of positive 

outcomes.

Drug overdose deaths fell significantly from 2017 to 4.1 percent for the first time in decades, the 

first significant decline in drug overdose deaths since the 1990’s. Deaths related to prescription 

painkillers may be driving the trends (CDC NCHS, 2019). Data from CDC also revealed that urban 

areas now see more overdose deaths rates than rural areas. In 2016 and 2017, the overall drug 

overdose death rate was 22.0 per 100,000 in urban counties compared to 20.0 per 100,000 for rural 
194

counties (** NCHS Data Brief # 345, August 2019). While prescription opioid overdoses are 

falling, other overdose categories continue to show troubling increases. Synthetic opiates including 

fentanyl continue to drive tens of thousands of deaths in 2018. Despite these troubling statistics, 

significant gaps persist between treatment needs and capacity. In 2012, 48 states and the District 

of Columbia reported levels of opioid addiction that were higher than their rates of MAT capacity. 

Furthermore, 38 states reported that at least 75 percent of their opioid treatment programs (OTPs) 

were operating at 80 percent or greater capacity. 67

The MAT-PDOA continuation grants expect to increase the number of individuals receiving 

services with pharmacotherapies approved by the Food and Drug Administration for the treatment 

of opioid use disorder (OUD); increase the number of individuals receiving integrated care; 

decrease the illicit opioid drug use at 6-month follow-up; and decrease prescription opioid use in a 

non-prescribed manner at 6-month follow-up.

The new MAT-PDOA grants will expand/enhance access to medication-assisted treatment (MAT) 

services for persons with an opioid use disorder (OUD) seeking or receiving MAT. This program’s 

focus is on funding organizations and tribes/tribal organizations within states identified as having 

the highest rates of primary treatment admissions for heroin and opioids per capita and includes 

those states with the most dramatic increases for heroin and opioids, based on SAMHSA’s 2015 

Treatment Episode Data Set (TEDS). The desired outcomes include: 1) an increase in the number 

of individuals with OUD receiving MAT 3) a decrease in illicit opioid drug use and prescription 

opioid misuse at six-month follow-up.

Program Evaluation

MAT-PDOA state grants: In 2017, approximately 3,100 individuals were served through the MATPDOA state grant program. At six-month follow-up, 60 percent of individuals served reported 

abstinence from illicit drug use at 6-month follow up equaling the 60 percent target. In 2018, there 

were approximately 4,400 clients served through the MAT-PDOA state grant program.

In FY 2018 SAMHSA funded 11 continuation MAT-PDOA state grants; and in FY 2019 funded 

six continuation grants.

MAT-PDOA expansion: In FY 2018, SAMHSA expanded its funding criteria to include state, 

political subdivisions in states, nonprofit organizations within states and tribes. SAMHSA funded 

128 new MAT- PDOA grants, 20 of which were tribes, to support program implementation and 

provided supplemental funding for direct technical assistance to the new FY 2018 grantees.

In FY 2019, SAMHSA funded an additional 30 unfunded applications from the FY 2018 funding 

opportunity announcement. 

In FY 2020, SAMHSA anticipates continuing funding for 156 grants and awarding eight unfunded 

applications from the FY 2018 funding opportunity announcement.

Targeted Capacity Expansion-Technology Assisted Care (TCE-TAC)

 67Jones, C. M., Campopiano, M., Baldwin, G., McCance-Katz, E. (2015). National and state treatment need and 

capacity for opioid agonist medication-assisted treatment. American Journal of Public Health, 105(8), e55-c63. 
195

Access to treatment remains inadequate for underserved populations living with drug/alcohol 

addiction and/or co-occurring mental illness and drug/alcohol addiction, such as those living in 

rural areas. A key component of this access challenge relates to a lack of dependable transportation 

and many organizations experience significant financial constraints in serving these rural 

populations. SAMHSA believes that behavioral healthcare providers who use health information 

technology (HIT) can help patients improve their access to necessary care and prevention services. 

For example, tele-health and tele-psychiatry can bring addiction medicine providers to clients in 

areas without local specialists. Web-based tools can improve communication and help deliver 

much-needed support and education. Health information technology approaches can also enable 

providers to document and coordinate better mental and substance abuse treatment services directly 

or via tele-psychiatry or telemedicine with families and other providers and specialists.

SAMHSA established the TCE-TAC grant program to address the lack of resources in the field 

necessary to adopt and implement health information technologies, including electronic health 

records (EHRs), smart phones, tablets, web-based technologies and applications to support 

tele- psychiatry and telemedicine. The program also addresses the behavioral healthcare providers’ 

need to expand and/or enhance their ability to communicate effectively with individuals in 

treatment, as well as monitor their health to ensure treatment and prevention services are available 

when and where needed.

TCE-TAC and its predecessor program, Targeted Capacity Expansion-Health Information 

Technology (TCE-HIT), have improved care delivery in 48 behavioral healthcare organizations 

across 23 states. In FY 2017, the TCE-TAC program included 12 additional grantees bringing the 

total number of grantees since 2011 to 60 behavioral healthcare organizations. Grantees have 

deployed all of the above-mentioned technologies to provide substance abuse treatment services 

directly or via remote service delivery (i.e., tele-psychiatry and telemedicine). In FY 2017, the 

TCE-TAC and TCE- HIT programs served roughly 882 individuals. As of August 2018, TCE-TAC 

program served roughly 981 unduplicated individuals, an increase of 99 individuals from the 

previous year. More specifically, there were 580 men (59.1 percent) and 400 (40.8 percent) women 

served. Health information technology clearly holds great potential for increasing access to 

treatment services and providing reliable exposure to meaningful health information for 

underserved individuals with mental illness and alcohol/drug addiction. Providing the means to 

sustain this technology is likely to be an ongoing challenge for these and similarly situated 

organizations. 

In FY 2018, SAMHSA funded 13 TCE-TAC grant awards for implementation and supplement for 

direct technical assistance.

Targeted Capacity Expansion-Peer to Peer (TCE-PTP)

Peer support is built on the premise that individuals in recovery from drug/alcohol addiction can be 

of great value through the sharing of their lived recovery experiences with those attempting to 

achieve and sustain recovery. Peer recovery support services, as an adjunct to clinical treatment, 

extend the reach of treatment beyond the clinical setting into the everyday environment of those 

seeking to achieve or sustain recovery from drug/alcohol addiction. Peer support and peer recovery 

support services have proven to reduce healthcare costs. Research studies indicate that recovery 

support service adjuncts appear to be helpful over and above treatment alone. 
196

There is a growing need to train and certify existing peer providers to address the increasing demand 

and diverse settings in which peer providers are employed. Since 2002, SAMHSA has awarded 

over 59 grants to community-based organizations to provide peer recovery support services to 

individuals in or seeking recovery from drug/alcohol addiction and their families. The primary 

objective of these services is to help individuals and families in search of recovery to obtain much 

needed support, sustain clinical treatment gains, engage in healthy community living, and improve 

overall quality of life. This grant program incorporates a peer-to-peer model, capitalizing on the 

expertise of those individuals with similar lived experience. 

The TCE-PTP program has reached over 16,000 individuals and their families. Significant strides 

have been made in helping program participants secure and maintain sobriety, cultivate

employment and educational opportunities, enhance their sense of social connection, improve their 

housing stability, and decrease involvement with the criminal justice system. 

Program Evaluation

Since the program’s inception, TCE-Peer-to-Peer has supported individuals in achieving and 

sustaining sobriety, and enhancing their education/employment opportunities as well as their 

housing stability. As of September 29, 2019, 17 of the TCE-PTP grants will be ending leaving the 

four (4) grants funded in FY 2019 for $250,000 each annually. These programs represent Recovery 

Community Organizations (RCOs) that provide peer-to-peer services to individuals in need of 

recovery support services (RSS) while addressing their substance use disorder (SUD) issues. Peer 

recovery support takes the form of outreach and engagement in a variety of settings (e.g. hospital 

ED, jails, institutions, homeless shelters, etc.), peer recovery coaching to individuals before, during, 

after, or in lieu of treatment, and peer navigator services (i.e. assisting individuals in recovery to 

obtain a driver’s license, employment, housing, childcare, etc.). Grantees are engaged in some or 

all of these activities. In this last grant cycle, the portfolio has served over 5,000 program 

participants to date. At six-month follow-up, more than 80 percent of program participants were 

able to maintain or engage in abstinence in the six months before their assessment. Significantly, 

their rates of enrollment in educational programs and/or securing employment increased 69 percent. 

In addition, stability in housing witnessed a 50 percent increase among participants.

Targeted Capacity Expansion – Special Projects

SAMHSA funded the TCE- Special Projects program beginning in FY 2019. The purpose of this 

program is to develop and implement targeted strategies for substance use disorder treatment 

provision to address a specific population or area of focus identified by the community. The purpose 

of the TCE program is to address an unmet need or underserved population; this program aims to 

enable a community to identify the specific need or population it wishes to address through the 

provision of evidence-based substance use disorder treatment and/or recovery support services.

In FY 2019, SAMHSA funded 23 new TCE-Special Projects grants and four continuation TCEPTP grants.

In FY 2020, SAMHSA anticipates funding 27 continuation grants for TCE-PTP and TCE-Special 

Projects.
197

The output and outcome measures for TCE-TAC, TCE-PTP, and TCE – Special Projects are part 

of the Treatment - Other Capacity Activities Outputs and Outcomes table shown on page 223.

Funding History

Fiscal Year Amount

FY 2017 $67,192,000

FY 2018 $95,192,000

FY 2019 $100,192,000

FY 2020 $100,192,000

FY 2021 $11,192,000

Budget Request

The FY 2021 President’s Budget is $11.2 million, a decrease of $89.0 million from the FY 2020 

Enacted level. This will continue support for TCE-PTP and TCE-Special Projects, but will end 

grants associated with MAT-PDOA. This funding is reallocated to the State Opioid Response grant 

program. These activities can be supported through the State Opioid Response grant program. 

SAMHSA will fund 23 TCE-Special Projects continuation grants and four new grants.
198

Outputs and Outcomes Table

 Program: Medication-Assisted Treatment for Prescription Drug and Opioid Addiction

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

1.3.01 Number of admissions for 

Medication Assisted Treatment 

(Output)

FY 2019: 3158

Target: 4400

(Target Not Met)

3158 Discontinued -3158

1.3.02 Number of clients receiving 

integrated care (Output)

FY 2018: 1243

Target: 1301

(Target Not Met)

1243 Discontinued -1243

1.3.03 Illicit drug use at 6-month 

follow-up (Outcome)

FY 2019: 57 %

Target: 62 %

(Target No Met)

57 % Discontinued -57 %
199

Pregnant and Postpartum Women

(Dollars in thousands) 

Programs of Regional & National Significance

FY 2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 2020

Pregnant and Postpartum Women....................................... $29,931 $31,931 $31,931 $---

Authorizing Legislation..................................Section 508 of the Public Health Service Act 

FY 2021 Authorization.................................................................................................. $29,931,000

Allocation Method....................................Competitive Grants/Contracts/Cooperative Agreements

Eligible Entities....................................................Domestic Public and Private Non-Profit Entities

Program Description and Accomplishments

Pregnant and post-partum women with a SUD need specialized treatment that focuses on their 

unique needs and the needs of their families. From 1992 to 2012, a steady four percent of women 

admitted to treatment for drug/alcohol addiction were pregnant. From FY 2003 through FY 2015, 

28.4 percent of pregnant and postpartum women who had custody of their children at intake 

reported illegal drug use in the past 30 days.

68 Since many traditional substance abuse treatment 

programs do not allow for the inclusion of children, a woman may be torn between the need to care 

for her dependent children and her need for treatment.69 The most popular drugs used by pregnant 

women are tobacco products, alcohol and marijuana. The nation’s opioid crisis has also added to 

this challenge for many pregnant and parenting women. The proportion of pregnant women 

entering treatment who reported any prescription opioid misuse increased substantially from two 

percent in 1992 to 28 percent in 2012, an increase of 173 percent, from 351 to 6,087 women.70 The 

proportion of pregnant women who entered treatment and reported prescription opioids as their 

primary substance use increased from one percent in 1992 to 19 percent in 2012, an increase of 344 

percent, from 124 to 4,268 women.71

Since 2003, the Pregnant and Postpartum Women program (PPW) has used a family-centered 

approach to provide comprehensive residential substance abuse treatment, prevention, and recovery 

support services for pregnant and postpartum women, their minor children, and for other family 

members (e.g., fathers of the children). The family-centered approach includes partnering with 

others to leverage diverse funding streams, encouraging the use of evidence-based practices, 

supporting innovation, and developing workforce capacity to meet the needs of these families. The 

PPW program provides services not covered under most public and private insurance. 

Services Available:

Based on an in-depth review of cross-site evaluation and performance data in FY 2014, SAMHSA 

built the current PPW program model on an evidence-based approach for serving pregnant and postpartum women in need of residential substance abuse treatment. The PPW family-centered 

 68 Internal SAMHSA performance data 69 Center for Substance Abuse Treatment. Substance Abuse Treatment: Addressing the Specific Needs of Women. 

Treatment Improvement Protocol (TIP) Series 51. HHS Publication No. (SMA) 09-4426. Rockville, MD: Substance

Abuse and Mental Health Services Administration, 2009.

70 Martin, C. E., Longinaker, N., & Terplan, M. (2015). Recent trends in treatment admissions for prescription opioid 

abuse during pregnancy. Journal of substance abuse treatment, 48(1), 37-42. 71 Ibid.
200

approach includes a variety of services and case management for women, children, and families. 

Services provided to women include: outreach; engagement; pre-treatment; screening and 

assessment; detoxification; substance misuse education; treatment; relapse-prevention; healthcare 

services, including mental health services; postpartum health care, including attention to 

depression, anxiety, and medication needs; parenting education and interventions; home 

management and life skills training, education, testing, and counseling; and treatment of hepatitis, 

HIV/AIDS, and other sexually transmitted diseases. 

Services available to children include screening and developmental diagnostic assessments 

addressing social, emotional, cognitive, and physical well-being; and interventions related to 

mental, emotional, and behavioral wellness. 

Services for families are family-focused programs that support family strengthening, including 

involvement with the child’s other parent. The PPW program also supports tobacco use counseling 

and interventions, screening and assessment for Fetal Alcohol Syndrome Disorders, and a traumainformed approach.

In FY 2018, SAMHSA funded 19 new PPW residential treatment grants and 19 continuation PPW 

grants, and supplements for direct technical assistance. 

In FY 2019, SAMHSA funded 36 residential treatment continuation grants, three new grants, and 

supplements for direct technical assistance. 

In FY 2020, SAMHSA anticipates funding 39 residential treatment continuation grants and 

supplements for direct technical assistance.

Pregnant and Postpartum Women Pilot

Section 501 of the Comprehensive Addiction and Recovery Act (CARA) increased accessibility 

and availability of services for pregnant women by expanding the authorized purposes of the PPW 

program to include the provision of outpatient and intensive outpatient services for pregnant 

women. Historically, the PPW program has only supported the provision of residential treatment 

services.

The PPW pilot provides grants to states to: 1) support family-based services for pregnant and 

postpartum women with a primary diagnosis of a substance use disorder, including opioid disorders; 

2) help state substance abuse agencies address the continuum of care, including services provided 

to women in nonresidential-based settings; and 3) promote a coordinated, effective and efficient 

state system managed by state substance abuse agencies by encouraging new approaches and 

models of service delivery. An evaluation of this program is underway to determine the 

effectiveness of the pilot.

In FY 2018, SAMHSA funded three new state PPW pilot grants and three continuation state PPW 

pilot grants, supplements for direct technical assistance, and one continuation evaluation contract. 

In FY 2019, SAMHSA funded six pilot continuation grants. 

In FY 2020, SAMHSA plans to fund three pilot continuation grants, and three new grants.
201

Program Evaluation

In FY 2017, SAMHSA began a three-year PPW cross-site evaluation to examine the effectiveness 

of the PPW Pilot Program. The evaluation results will be used broadly to improve the collective 

understanding about effective components of the continuum of care for pregnant and postpartum 

women with a primary diagnosis of a substance use disorder, including whether the PPW Pilot 

Program is an effective approach to increase access to the use of medication-assisted treatment.

The Pregnant and Postpartum Women Program has enhanced and expanded statewide capacity to 

offer comprehensive family-centered treatment, prevention and recovery services in residential and 

nonresidential treatment settings for pregnant and postpartum women, their minor children (age 17 

and under), fathers of the children, partners of the women, and other family members of the women 

and children. The program has demonstrated benefits in the following: increasing access to 

medications for substance use disorders, mental disorders, and primary health conditions; 

integrating peer recovery approaches to engage and retain women in care; incorporating home 

visiting as part of the continuum of care, as a key strategy, to extend services to support recovery; 

and providing opportunities to increase access to care for diverse populations of women, 

particularly for those living in rural and remote locations in southern states.

Funding History

Fiscal Year Amount

FY 2017 $19,931,000

FY 2018 $29,931,000

FY 2019 $29,931,000

FY 2020 $31,931,000

FY 2021 $31,931,000

Budget Request

The FY 2021 President’s Budget is $31.9 million, level with the FY 2020 Enacted level. SAMHSA 

intends to fund three PPW pilot continuations, three new pilot grants, 39 residential treatment grant 

continuations, to provide an array of services and supports to pregnant women and their children. 
202

Outputs and Outcomes Table

Program: Pregnant and Postpartum Women Program

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

1.2.84 Number of admissions of 

women who are currently pregnant or 

have a child to substance abuse 

treatment programs (Output)

FY 2018: 801.0

Target: 801.0

(Baseline)

825.0 825.0 Maintain

1.2.85 Percentage of PPW clients 

reporting no drug use in the past 

month at six month follow-up 

(Outcome)

FY 2019: 86.9

Target: 90.0

(Target Not Met)

90.0 90.0 Maintain

1.2.86 Percentage of PPW clients 

who reported substance misuse at 

intake, percent who report reduction 

in substance misuse at six month 

follow-up (Outcome)

FY 2019: 94.0

Target: 87.0

(Target Exceeded)

89.0 89.0 Maintain

1.2.87 Percentage of PPW clients 

who reported child/children not 

living with client at intake, percent 

who report child/children is living 

with client at six month follow-up 

(Outcome)

FY 2018: 46.0

Target: 46.0

(Baseline)

50.0 55.0 +5

1.2.88 Number of women who are 

currently pregnant or have a child 

who receive SUD and related 

treatment services (Outcome) 

(Outcome)

FY 2018: 897.0

Target: 897.0

(Baseline)

1,800.0 1,800.0 Maintain
203

Recovery Community Services Program

(Dollars in thousands) 

Programs of Regional & National Significance

FY 2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 2020

Recovery Community Services Program............................. $2,434 $2,434 $2,434 $---

 Authorizing Legislation ...........................................Section 509 of the Public Health Service Act

FY 2021 Authorization................................................................................................ $333,806,000

Allocation Method....................................Competitive Grants/Contracts/Cooperative Agreements

Eligible Entities..........................................................Family/Consumer Controlled Organizations,

Domestic Public and Private Non-Profit Organizations in States, Territories, and Tribes, Recovery 

Community Organizations of Domestic Private Non-Profit Entities in States, Territories, and 

Tribal Organizations 

Program Description and Accomplishments

An estimated 24 million people in the United States are in recovery from addiction to alcohol and 

other drugs.72 As public education increases, there is broader acknowledgement of addiction as a 

treatable condition that needs to be managed over the course of a lifetime. More people in recovery 

are now willing to be open about their own recovery and to share their experience to help others 

attempting to achieve recovery. Through the use of their lived experience, individuals in recovery 

can provide support and hope to those newly seeking recovery. 

Since 1998, SAMHSA has recognized the value of supporting recovery through peers and other 

recovery supports, and has provided funding through the Recovery Community Services Program 

(RCSP). RCSP was designed to assist recovery communities to strengthen their infrastructure and 

provide peer recovery support services to those in or seeking recovery from alcohol/other drug 

addiction across the nation. The delivery of recovery support services (RSS) by people in recovery 

is known as peer recovery support services (PRSS). PRSS are a vital component in helping 

individuals and families address substance abuse in the context of chronic disease management, 

especially when delivered by a Peer (often known as a Recovery Coach, Peer Specialist, or Peer 

Mentor). SAMHSA initiated RCSP to help build an infrastructure for PRSS programs to support 

the development and expansion of peer recovery services. These peer services are most frequently 

offered by Recovery Community Organizations (RCOs). 

Though the RCSP was a services program from 2002-2010, it was evident that this approach needed 

to be taken system-wide to have a broader effect. Many states finally recognize the value of 

addiction peer recovery services; however, further efforts are required to realize the potential of 

these services and supports at a system-wide level. The infusion of these services into state systems 

ensures the wide scale adoption of peer recovery support. By developing a workforce of trained 

and certified peers and engaging recovery community organizations in the full continuum of 

treatment and recovery services, states have the ability to enhance their systems to ensure holistic 

approaches to care. SAMHSA supports this state system development effort through the RCSP 

Statewide Network grant program. Since the inception of the RCSP, over 120 grants have been 

 72 Partnership for Drug Free Kids, March, 20152012. Retrieved from http://www.drugfree.org/newsroom/survey-tenpercent-of-american-adults-report-being-in-recovery-from-substance-abuse-or-addiction
204

awarded to RCOs to expand PRSS locally and lay the groundwork for a national network of PRSS 

programs.

Recovery Community Services Program Statewide Network (RCSP-SN)

The RCSP-SN grant program supports a statewide approach to enhance the presence of people with 

lived experience in recovery from drug/alcohol addiction as key partners in state systems, as well 

as building a peer workforce. Activities include collaborating on local and state workforce 

development, developing linkages with other organizations that promote recovery throughout the 

state, and participating in policy, planning, and program development discussions at the state, 

community, and local level. Involving recovery community leaders and key stakeholders in 

decision-making helps states to design peer services and PRSS programs that are authentic to the 

recovery experience, complementary to clinical practice, demonstrate strong recovery outcomes, 

and are sustainable over time. The statewide networks help to ensure the development of a trained, 

qualified, and effectively supervised peer workforce.

Workforce outcomes for the program include the expanding the extent of training provided, 

increasing the number of people trained, enhancing trainee satisfaction, and the effectiveness of 

information presented. Other key outcomes include: the number of RCOs that have been linked 

across the state; the number of state-sponsored events where participation of the statewide network 

occurred; the effects of linkages with behavioral health and other health systems; the outcomes of 

program activities on raising awareness about addiction peer recovery support; and the number of 

policy/program discussions which included addiction peer recovery support as a result of project 

efforts.

In addition to workforce development, the 13 RCSP-SN grants enhance the presence of RCOs as 

key partners in treatment, recovery, and affiliated health systems. RCSP-SN grantees are engaged 

in regional and/or statewide infrastructure or capacity building activities where grantees seek to 

leverage resources, educate state legislatures and senior executive branch level leaders, and the 

public about the importance of recovery supports. A primary goal for these grants is to ensure that 

those in their respective jurisdictions regard the stakeholders in the recovery community as critical 

partners in state and local planning and when discussing the funding of and planning for treatment 

and recovery support services. In addition to public health messaging, all grantees work to reduce 

stigma around SUDs by engaging family members, civic institutions, and the public at large. 

Recovery Month activities, held each September, are another way these programs enhance the voice 

of recovery through activities like recovery walks and rallies. These projects continue to emphasize 

the importance of sustainability through the diversification of revenue streams by RCOs working 

with their state Medicaid Plan Offices and local Managed Care Organizations interested in 

Recovery Support Services (RSS) to seek reimbursement for the delivery of peer-based recovery 

support services in statewide reform initiatives. 

Due to the nature of these programs, data is almost strictly limited to qualitative reporting in the 

form of Best Practices reflecting events and activities conducted, trainings held, technical assistance 

provided, and participant input and feedback offered accordingly. For the 13 grantees, Best 

Practices findings thus far indicate over 2,800 participants have been served, an 86 percent 

participant coverage rate, and 396 events have been held over the past two years achieving a 125 

percent event coverage rate.

In FY 2018, SAMHSA funded 10 continuation RCSP-SN grants and three new grants. 
205

In FY 2019, SAMHSA funded 13 RCSP-SN continuation grants. In addition, these grantees 

received supplements for direct training and technical assistance. 

In FY 2020, SAMHSA anticipates funding three RCSP-SN continuation grants, and nine new 

RCSP grants.

The output and outcome measures for Recovery Community Services Program are part of the 

Treatment - Other Capacity Activities Outputs and Outcomes table shown on page 223.

Funding History

Fiscal Year Amount

FY 2017 $2,434,000

FY 2018 $2,434,000

FY 2019 $2,434,000

FY 2020 $2,434,000

FY 2021 $2,434,000

Budget Request

The FY 2021 President’s Budget is $2.4 million, level with the FY 2020 Enacted level. SAMHSA 

intends to fund the continuation of nine RCSP grants, and three new grants to continue the efforts 

of building addiction recovery networks throughout the nation and the collaboration among peerrun organizations. 
206

Children and Families

(Dollars in thousands)

Programs of Regional & National Significance

FY 2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 2020

Children and Families....................................................... $29,605 $29,605 $29,605 $---

 Authorizing Legislation ........................... Sections 509 and 514 of the Public Health Service Act

FY 2021 Authorization.................................................................................................. $29,605,000

Allocation Method....................................Competitive Grants/Contracts/Cooperative Agreements

Eligible Entities.............................................................................Single States Agencies in States, 

Territories, District of Columbia, public and private non-profit entities, 

Federally Recognized American Indian/Alaska Native Tribes Tribal Organizations, and health 

facilities or programs operated by or in accordance with a contract or grant with the 

Indian Health Service

Program Description and Accomplishments

Substance abuse plays a significant role in the lives of many children and youth (ages 12 to 25) 

throughout the nation. In 2018, approximately 8 percent of adolescents between the ages of 12 and 

17 and 24 percent of youth between the ages of 18 and 25 reported current illicit drug use. Less 

than two percent of adolescents between the ages of 12 and 17, and 10 percent of youth between 

the ages of 18 and 25 met the criteria for an alcohol use disorder. Many of these youth have cooccurring mental and substance use disorders. Most substance abuse begins during adolescence, 

making this developmental period a critical time for intervention. Approximately four percent of 

admissions to substance abuse treatment facilities were adolescents in 2017. Sixty-one percent of 

infants and 41 percent of older children involved in the child welfare system have at least one parent 

who is using alcohol or other drugs. Of children removed from their household and placed in foster 

care, nearly 35 percent can attribute the removal to instances where one or both parents had 

substance misuse or substance use disorders. 

SAMHSA’s Children and Families program makes appropriate treatment available to youth and 

their families/caregivers to reduce the impact of substance abuse and/or co-occurring mental and 

substance abuse on communities in the U.S.

Substance Abuse Treatment for Youth 

In 2015, less than 7 percent of adolescents ages 12 to 17 and 8 percent of youth ages 18 to 25 who 

needed treatment received the needed treatment at a specialty facility.73 Youth have psychological, 

developmental, and emotional needs that are distinct from adults. The neurological and 

developmental differences between youth and adults require tailored treatment and recovery 

approaches for youth with alcohol/other drug addiction. 

 
207

SAMHSA’s programs to treat youth with addiction and/or co-occurring substance abuse and mental 

disorders address gaps in service delivery by providing services for youth and their families and 

primary caregivers using effective evidence-based, family-centered practices. SAMHSA supports 

a youth treatment grant initiative at the state, territorial, and tribal levels. The populations of focus 

for the initiatives are adolescents (ages 12 to 17), transition-aged youth (ages 18 to 25), and their 

families and caregivers. 

This initiative helps to further the use of, and access to, effective evidence-based family-centered 

treatment approaches for youth with alcohol/other drug addiction. It supports training across 

participating states and collaboration between local community-based providers and their state, 

tribal, or territorial infrastructure. The services provided include evidence-based assessment and 

treatment interventions appropriate for adolescents and transition age youths. 

In FY 2018, SAMHSA developed a new grant program called Enhancement and Expansion of 

Treatment and Recovery Services for Adolescents, Transitional Aged Youth, and their Families

(Youth and Family TREE). Its purpose is to enhance and expand comprehensive treatment, early 

intervention, and recovery support services for adolescents (ages 12-18), transitional aged youth 

(ages 16-25), and their families/primary caregivers with SUD and/or co-occurring substance use 

and mental disorders. Eligibility includes public and private non-profit entities. Youth and Family 

TREE is focused on: increasing the unduplicated number of individuals served with evidence-based 

services and practices; increasing abstinence from the use of opioids, alcohol, marijuana, and other 

substances; increasing access, engagement, and retention in treatment, including medication 

assisted treatment; improving parenting skills and family functioning; improving mental health; and 

increasing access to health services for underserved populations, specifically federally recognized 

American Indian/Alaskan Native tribes and tribal organizations. 

In FY 2018, SAMHSA funded 31 new Youth and Family TREE grants, 11 continuing youth 

treatment implementation grants for program implementation, and supplements for direct technical 

assistance. Note that 11 of the 31 new grants are federally recognized American Indian/Alaskan

Native tribes and tribal organizations. 

In FY 2019, SAMHSA funded four new Youth and Family TREE grants, 31 continuing Youth and 

Family TREE grants, 11 continuing youth treatment implementation grants, and supplements for 

direct technical assistance.

In FY 2020, SAMHSA plans to fund 35 Youth and Family TREE continuation grants and 11

continuing youth implementation grants.

Program Evaluation

Based on FY 2019 data to date for adolescent treatment programs, 50.6 percent of clients report 

abstinence from substance use at a six-month follow-up, 86.2 percent of clients report being 

engaged in employment of educational activities and 67.7 percent of clients report having a stable 

place to live.

The percentage of matched-case clients who reported that they had injected drugs within the past 

30 days decreased from 9.5 percent at intake to 2.7 percent at 6-month follow-up (N=451); the 

percentage of clients who reported having unprotected sexual contact increased from 76.1percent 

at intake to 77 percent at 6-month follow-up (N=113); the percentage of clients who reported having 
208

unprotected sexual contact with an individual who is or was HIV+ or has AIDS within the past 30 

days remained the same at zero percent between intake and 6-month follow-up (N=71); the 

percentage of clients who reported having unprotected sexual contact with an injection drug user 

within the past 30 days decreased from 17 percent at Intake to 7 percent at 6-Month Follow-Up 

(N=71); and the percentage of clients who reported having unprotected sexual contact with an 

individual high on some substance decreased from 25 percent at intake to 14 percent at 6-month 

follow-up (N=71).

Addressing Child Abuse and Neglect

SAMHSA and the Administration for Children and Families (ACF) collaborate to address child 

abuse and neglect by supporting a National Center on Substance Abuse and Child Welfare 

(NCSACW). NCSACW provides training and technical assistance to improve collaborative 

practices among agencies and organizations that serve families affected by substance use disorders 

and involvement with child welfare services. From January 2018 through November 2018, 

NCSACW responded to 562 requests for technical assistance and facilitated 55 events (including 

site visits, conference presentations, and webinars and virtual trainings) attended by an estimated 

4,730 participants.

The NCSACW website receives approximately 60,000 visitors per year and features resources, 

reports, guidance documents, webinar recordings, and videos. NCSACW provides three web-based 

tutorials on serving families affected by substance use disorders for three audiences: substance use 

disorder treatment, child welfare, and court professionals. From 2007 through October 2018, there 

were 38,952 tutorial completions with a 97 percent completion rate. NCSACW provides a child 

welfare training toolkit entitled Helping Child Welfare Workers Support Families with Substance 

Use, Mental, and Co-Occurring Disorders Training Package to educate child welfare professionals 

about substance use and mental health disorders. This is among families involved in the child 

welfare system and is currently revising the content of this training toolkit to highlight new research 

and best practices, working with families affected by opioid use disorders and developing Plans of 

Safe Care. NCSACW’s activities have assisted professionals throughout the nation to improve 

cross-system collaboration and meet child welfare requirements for timely child permanency 

decisions.
209

NCSACW continues to provide training and technical assistance to tribes, state agencies, and 

communities to develop collaborative approaches to the treatment of pregnant women with opioid 

use disorders and their infants and families. Since August 2016, NCSACW has disseminated 

SAMHSA’s A Collaborative Approach to the Treatment of Pregnant Women with Opioid Use 

Disorders: Practice and Policy Considerations for Child Welfare, Collaborating Medical and 

Service Providers to child welfare, substance use treatment, dependency court, and medical 

professionals. The publication has been downloaded over 2,700 times from the NCSACW website 

from its 2016 release through October 2018. In addition, the NCSACW is providing In-Depth TA 

(IDTA) on addressing the needs of pregnant and parenting women with opioid and other substance 

use disorders and their infants and families to the five states. Since September 2016, NCSACW 

has responded to 652 TA requests on Plans of Safe Care, the provisions related to prenatal substance 

exposure in the Child Abuse and Prevention Treatment Act (CAPTA), and infants with prenatal 

substance exposure.

In May 2018, NCSACW facilitated a Tri-Regional Convening focused on pregnant and parenting 

women with substance use disorders and changes to the Child Abuse Prevention and Treatment Act 

(CAPTA) by the Comprehensive Addiction and Recovery Act (CARA) regarding identification, 

notification and monitoring of plans of safe care for infants affected by substance abuse, withdrawal 

symptoms or fetal alcohol spectrum disorders. NCSACW used their TA tool A Planning Guide: 

Steps to Support a Comprehensive Approach to Plans of Safe Care to support the 17 state teams 

from Regions 4, 6 & 7 in action planning for development or enhancement of collaborative 

approaches to Plans of Safe Care.

In FY 2018 and FY 2019, SAMHSA provided continuation support for the NCSACW technical 

assistance contract. In FY 2020, SAMHSA plans to continue support of this technical assistance 

contract. 

The output and outcome measures for Children and Families are part of the Treatment - Other 

Capacity Activities Outputs and Outcomes table shown on page 223.

Funding History

Fiscal Year Amount

FY 2017 $29,605,000

FY 2018 $29,605,000

FY 2019 $29,605,000

FY 2020 $29,605,000

FY 2021 $29,605,000
210

Budget Request

The FY 2021 President’s Budget level is $29.6 million, level with the FY 2020 Enacted. SAMHSA 

intends to fund 11 new State and Tribal Youth Implementation grants. These new grants will 

support states and tribes who have not previously received funds under this initiative. This will 

enable states to fund youth treatment capacity. Additionally, 35 Youth and Family Tree 

continuation grants will be funded. These funds will continue to address the gaps in substance 

abuse treatment by providing services for youth, their families, and caregivers. These funds will 

also continue to support for the NCSACW technical assistance contract.
211

Treatment Systems for Homeless

(Dollars in thousands) 

Programs of Regional & National Significance

FY 2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 2020

Treatment Systems for Homeless............................................. $36,386 $36,386 $36,386 $---

 Authorizing Legislation ...........................................Section 506 of the Public Health Service Act

FY 2021 Authorization.................................................................................................. $41,304,000

Allocation Method.............................................................................Competitive Grants/Contracts

Eligible Entities........................................States, Domestic Public and Community Organizations,

Private Nonprofit Entities, and Community-based Public or Nonprofit Entities

Program Description and Accomplishments

SAMHSA’s Treatment Systems for Homeless portfolio supports services for those with 

alcohol/other drug addiction and who are experiencing homelessness, including youth, veterans, 

and families.

The number of individuals experiencing chronic homelessness declined by 26 percent, or over 

31,173 people, between 2007 and 2018.74 On a single night in January 2018, 552,830 people were 

experiencing homelessness in the United States. Of these individuals, 96,913 were experiencing 

chronic homelessness, 111,122 had severe mental illness, 86,647 were affected by chronic 

substance abuse, and 37,878 were veterans.75

Many factors contribute to the problem of homelessness, including lack of affordable housing, 

foreclosures, rising housing costs, job loss, underemployment, mental illness, and drug/alcohol 

addiction. The progress made to date in reducing homelessness points to improvement in services, 

as well as the effectiveness of collaboration across all levels, from the federal government to state 

governments and community systems. The U.S. Interagency Council on Homelessness, in which 

HHS participates, has set aggressive goals to prevent and end homelessness. These goals include 

ending homelessness among veterans, people with disabilities, families with children, 

unaccompanied youth, and all other individuals. The services and support offered through 

SAMHSA’s Treatment Systems for Homeless programs are crucial to achieving these goals. 

SAMHSA manages the following Treatment Systems for Homelessness grant programs: 

 74 The U.S Department of Housing and Urban Development, Office of Community Planning and Development 

(2018). The 2018 Annual Homeless Assessment Report (AHAR) to Congress, Part 1. Retrieved from 

https://www.hudexchange.info/resources/documents/2018-AHAR-Part-1.pdf 75 U.S. Department of Housing and Urban Development (HUD) 2018 Continuum of Care (CoC) Homeless 

Populations and Subpopulations Report – Retrieve from 

https://www.hudexchange.info/resource/reportmanagement/published/CoC_PopSub_NatlTerrDC_2018.pdf
212

Cooperative Agreement to Benefit Homeless Individuals (CABHI)

In FY 2011, SAMHSA initiated the Cooperative Agreement to Benefit Homeless Individuals 

(CABHI) program, jointly funded by the Center for Mental Health Services (CMHS) and the Center 

for Substance Abuse Treatment (CSAT) (Treatment for Homeless line) to support treatment 

services and the development and expansion of local systems that provide permanent housing and 

supportive services. This includes integration of treatment and other critical services for individuals 

with substance use disorders, SMI, or co-occurring mental and substance use disorders.

In FY 2019, SAMHSA funded 16 CABHI continuation grants with grant supplements for direct 

technical assistance.

Program Evaluation

Based on FY 2018 data for CABHI programs, 60.0 percent of clients report abstinence from 

substance use at a six-month follow- up, while approximately 28.7 percent of clients report being 

employed or engaged in productive activities and 54.3 percent of clients report having a permanent 

place to live in the community.76

Grants for the Benefit of Homeless Individuals (GBHI)

The GBHI program supports the development and/or expansion of local implementation of a 

community infrastructure that integrates treatment and recovery support services for substance use 

disorders or co-occurring mental and substance use disorders, permanent housing, and other critical 

services for individuals (including youth) and families experiencing homelessness. 

In FY 2018, SAMHSA funded 33 new GBHI grants and 17 GBHI continuation grants, with grant 

supplements for direct technical assistance. SAMHSA also supported a contract for direct technical 

assistance. 

In FY 2019, SAMHSA funded 22 new GBHI grants and 50 continuation grants with grant 

supplements for direct technical assistance, and provided continued support for the technical 

assistance contract.

In FY 2020, SAMHSA anticipates funding 14 new GBHI grants and 72 continuation grants.

Program Evaluation

Based on FY 2018 data for GBHI programs, 51.3 percent of clients reported abstinence from 

substance use at a six-month follow-up, while approximately 30.6 percent of clients reported being 

employed or engaged in productive activities and 33.0 percent of clients reported having a 

permanent place to live in the community.77

 

 76 SPARS. (2018). Retrieved from www.samhsa-gpra.samhsa.gov. 77 SPARS. (2018). Retrieved from www.samhsa-gpra.samhsa.gov.
213

Funding History

Fiscal Year Amount

FY 2017 $36,386,000

FY 2018 $36,386,000

FY 2019 $36,386,000

FY 2020 $36,386,000

FY 2021 $36,386,000

Budget Request

The FY 2021 President’s Budget is $36.4 million, level with the FY 2020 Enacted level. This 

funding is to support grants to reduce homelessness for nearly 5,000 people. SAMHSA intends to 

fund 86 GBHI continuation grants with grant supplements for direct technical assistance. 
214

Outputs and Outcomes Table

 Program: Treatment System for Homelessness (GBHI)

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

3.4.23 The number of clients served 

(Output)

FY 2019: 3521

Target: 4600

(Target Not Met)

3521 3521 Maintain

3.4.24 Percentage of homeless clients 

receiving services who were currently 

employed or engaged in productive 

activities (Outcome)

FY 2019: 34.4 %

Target: 20 %

(Target Exceeded)

34.4 % 34.4 % Maintain

3.4.25 Percentage of clients receiving 

services who had a permanent place to 

live in the community (Outcome)

FY 2019: 31.1 %

Target: 70 %

(Target Not Met)

31.1 % 31.1 % Maintain
215

Minority AIDS

(Dollars in Thousands) 

Programs of Regional & National Significance

FY 2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 2020

Minority AIDS.......................................................................... $65,570 $65,570 $65,570 $---

 Authorizing Legislation..................................Section 509 of the Public Health Service Act

FY 2021 Authorization................................................................................................ $333,806,000

Allocation Method....................................Competitive Grants/Contracts/Cooperative Agreements

Eligible Entities....................................................Domestic Public and Private Non-Profit Entities

Program Description and Accomplishments

SAMHSA’s Minority AIDS Initiative (MAI) funded programs are making a significant 

contribution in addressing HIV and hepatitis infection by facilitating the development and

expansion of culturally competent and effective community-based treatmentsystemsforsubstance

use and co-occurring mental disorder treatment within racial and ethnic minority communities.

The purpose of the Targeted Capacity Expansion-HIV program is to increase engagement in care 

for racial and ethnic minority individuals with substance use disorders (SUD) and/or co-occurring 

substance use and mental disorders (COD) who are at risk for HIV or HIV positive that receive 

HIV services/treatment. Populations of focus for the TCE-HIV programs include African

American, Hispanic/Latina, and other racial/ethnic minority women ages 18 years and older; 

black young men who have sex with men (YMSM) (ages 18-29); other high-risk populations such 

as Latino YMSM and men who have sex with men (MSM) (ages 30 years and older); and gay, 

bisexual, and transgender individuals who have a SUD or COD, are HIV positive or at risk for 

HIV/AIDS and hepatitis. The MAI program, along with many other HIV/AIDS programs across 

HHS, supports and contributes to the goals of a new initiative to eliminate new HIV infections in 

our nation entitled ‘Ending the HIV Epidemic: A Plan for America’ with reaching particularly 

vulnerable populations.

Between FY 2000 to FY 2018, the TCE-HIV program served 154,454 clients. Significant steps 

have been taken to increase abstinence, employment and educational opportunities, social 

connectedness and housing stability. In FY 2019, the percentage of clients who reported that they 

did not use alcohol or illegal drugs within the past 30 days increased by 62.3 percent between intake 

to 6-month follow-up (N=1,483). Between intake and six-month follow-up, the percentage of 

clients who reported no arrests within the past 30 days increased by 4.7 percent (N=1,443). In 

addition, the percentage of clients who were employed or attending school increased by 40.6 

percent between intake to 6-month follow-up (N=1,455). Those clients who reported being socially 

connected increased by 5.6 percent from intake to 6-month follow-up (N=1,466). The percentage 

of clients who reported housing stability increased by 8.4 percent between intake and 6-month 

follow-up (N=1,485)78.

 31 SAMHSA. (2019, August). CSAT GPRA Modernization Act Discretionary Services Tools. Retrieved from 

https://www.samhsa.gov/grants/gpra-measurement-tools/csat-gpra/csat-gpra-discretionary-services
216

In FY 2018, SAMHSA funded 36 new TCE-HIV grants, 59 TCE-HIV continuations, and 

supplements for direct technical assistance. 

In FY 2019, SAMHSA funded 26 new TCE-HIV grants, 95 TCE-HIV continuation grants, and 

supplements for direct technical assistance.

In the FY 2020, SAMHSA will fund 121 continuation grants. 

Funding History

Fiscal Year Amount

FY 2017 $65,125,000

FY 2018 $64,534,000

FY 2019 $65,570,000

FY 2020 $65,570,000

FY 2021 $65,570,000

Budget Request

The FY 2021 President’s Budget is $65.6 million, level with the FY 2020 Enacted level. SAMHSA 

plans to fund 121 continuation grants. 
217

Criminal Justice Activities

(Dollars in thousands) 

Programs of Regional & National Significance

FY 2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 2020

Criminal Justice Activities....................................................... $89,000 $89,000 $89,000 $---

Other Criminal Justice Activities (non-add).................... 19,000 19,000 19,000 ---

Drug Court Activities (non-add).......................................... 70,000 70,000 70,000 ---

Authorizing Legislation ............................................Section 509 of the Public Health Service Act

FY 2021 Authorization................................................................................................ $333,806,000

Allocation Method....................................Competitive Grants/Contracts/Cooperative Agreements

Eligible Entities...............................Domestic Public and Private Non-Profit Entities, Operational

Individual Misdemeanor and Felony Adult Criminal Courts,

Municipal Courts, Tribal, State, Local Government Proxies,

Government with Direct Involvement with Adult Criminal Courts,

Tribal Organizations and Individual Adult Tribal Healing to Wellness Courts, and

 Public or private universities and colleges and 

Community- and faith-based organizations

Program Description and Accomplishments

SAMHSA’s Criminal Justice portfolio includes several grant programs that focus on diversion, 

alternatives to incarceration, drug courts, and re-entry from incarceration for adolescents and adults 

with drug/alcohol addiction and/or co-occurring drug/alcohol addiction and mental illness.

Drug Courts

According to a 2017 Bureau of Justice Statistics (BJS) Special Report, approximately 14 percent of 

state and federal prisoners, and 26 percent of jail inmates reported experiences that met the 

threshold for serious psychological distress (SPD) in the 30 days prior to a survey that was 

conducted between February 2011 and May 2012.79 More than half (58 percent) of state prisoners 

and two-thirds (63 percent) of sentenced jail inmates met the criteria for drug dependence or abuse, 

according to data collected 2007-2009.80 An estimated 42 percent of state prisoners and 49 percent 

of jail inmates met the criteria for both a mental illness and drug/alcohol addiction.81 According to 

BJS, there were 10.6 million jail admissions in 2016.

82 At mid-year 2016, city and county jails held 

over 740,000 individuals.83 Although the corrections system faced a decline in its prison population 

 79 Bronson, J., & Berzofsky, M., (2017). Indicators of Mental Health Problems Reported by Prisoners and Jail 

Inmates, 2011-12. Washington, D.C.: Bureau of Justice Statistics. Available: 

https://www.bjs.gov/content/pub/pdf/imhprpji1112.pdf

80 Bronson, J., Stroop, J., Zimmer, S. & Berzofshi, M., (2017). Drug Us, Dependence, and Abuse AmongState 

prisoners and jail Inmates, 2007-2009. Washington, D.C.: Bureau of Justice Statistics. Available: 

https://www.bjs.gov/content/pub/pdf/dudaspji0709.pdf 81 James, D. J., & Glaze, L. E. (2006). Highlights mental health problems of prison and jail inmates. Retrieved from 

https://www.bjs.gov/index.cfm?ty=pbdetail&iid=789

82 Zeng, Z. (2018). Jail Inmates in 2016. Washington, D.C.: Bureau of Justice Statistics. Available: 

https://www.bjs.gov/content/pub/pdf/ji16.pdf

83 Ibid.
218

for the third consecutive year, more than 1.5 million Americans were incarcerated in 2016.84 In 

2016, the rate of imprisonment for adult Americans was 450 per 100,000 U.S. residents.85

Referral source for substance abuse treatment

The criminal justice system was the major source of referrals to substance abuse treatment, with 

probation or parole referrals representing the largest proportion of criminal justice system referrals 

to treatment.86

Most probation or parole referrals to treatment were men between the ages of 18 and 44. The most 

common substances reported by these referrals were alcohol, marijuana, and methamphetamine.87

Drug Court Purpose

Drug courts are designed to combine the sanctioning power of courts with effective treatment 

services for a range of populations with circumstances, such as alcohol and/or other drug use, child 

abuse/neglect, criminal behavior, or people with mental illness. Drug courts represent the 

coordinated efforts of the judiciary, prosecution, defense bar, probation, law enforcement, mental 

health, social service, and treatment communities to intervene and break the cycle of substance 

misuse, addiction, and crime. Stakeholders work together to give individual clients the opportunity 

to improve their lives, including recovery from substance drug/alcohol addiction, and develop the 

capacity and skills to become fully functioning parents, employees, and citizens. 

Why fund drug courts?

Many drug courts lack sufficient funding or the ability to implement evidence-based practices for 

substance abuse treatment and recovery services.88 Through its Treatment Drug Court grant 

programs, SAMHSA seeks to reduce this gap in treatment services while also improving treatment 

services by requiring that evidence-based practices be used. SAMHSA’s interest is to support and 

shape treatment drug courts that serve clients with drug/alcohol addiction in the respective problemsolving court models as long as the court meets all the elements required for drug courts. The intent 

is to meet the treatment needs of clients using evidence-based practices consistent with the disease 

model and the problem-solving model, rather than with the traditional court case-processing model. 

A long-term goal of this program is to build sustainable systems of care for individuals needing 

treatment drug court services. SAMHSA’s Treatment Drug Court grant programs seek to address 

behavioral health disparities among racial and ethnic minorities by encouraging the implementation 

of strategies to decrease the differences in access, service use, and outcomes among the racial and 

ethnic minority populations served. 

Drug Court Services

 84 Carson, E. A. (2018). Prisoners in 2016. Washington, D.C.: Bureau of Justice Statistics. Available: 

https://www.bjs.gov/content/pub/pdf/p16.pdf 85 Ibid. 86 Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. 

Treatment Episode Data Set (TEDS): 2005-2015. National Admissions to Substance Abuse Treatment Services. 

BHSIS Series S-91, HHS Publication No. (SMA) 17-5037. Rockville, MD: Substance Abuse and Mental Health 

Services Administration, 2017.

87 SAMHSA. (2015). Criminal and Juvenile Justice. Retrieved from http://www.samhsa.gov/criminal-juvenile-justice 88 SAMHSA's GAINS Center for Behavioral Health and Justice Transformation. (n.d.). Adult Mental Health 

Treatment Courts Database. Retrieved from http://gainscenter.samhsa.gov/judgescourts/courtsjudges.asp
219

SAMHSA’s Adult Drug Court programs support a variety of services including direct treatment 

services for diverse populations, wraparound and recovery support services such as recovery 

housing and peer recovery support services designed to improve access and retention, drug testing 

for illicit substances, educational support, relapse prevention and long-term management, and HIV 

and viral hepatitis B and C testing conducted in accordance with state and local requirements. 

Medication-Assisted Treatment

SAMHSA’s Adult Drug Court grant programs are encouraged to use part of their annual award to 

provide medication-assisted treatment (MAT) and are required to ensure that drug courts funded by 

SAMHSA-funded drug courts cannot deny the use of Food and Drug Administration (FDA)-

approved medications for opioid addiction to drug court clients. Drug court judges, however, retain 

judicial discretion in cases where specified conditions for pharmacotherapy provisions were not 

met. 

Evidence-based Services

These grant programs use existing evidence from numerous studies to support current programs 

and new proposals. There have been more than 125 evaluation and research studies of the 

effectiveness of drug courts in addition to Government Accountability Office reports. SAMHSA 

requires evidence-based practices from federal inventories to be used. SAMHSA also has regular 

communications with the National Association of Drug Court Professionals to obtain and 

incorporate the latest findings and field expertise.

Program Evaluation

Performance data show that these grant programs are effective in improving the lives of drug court 

participants. Based on FY 2018 SAMHSA data, 4,927 clients received services through 

SAMHSA’s Adult Treatment Drug Court Programs. Of these clients at six-month follow-up, 87.0 

percent reported that they did not use alcohol or illegal drugs within the past 30 days. Additionally, 

there was an 8.9 percent increase from intake that had no involvement with the criminal justice 

system, a 47.2 percent increase of adult clients that were either employed or attending school, and 

a 39.5 percent increase in clients who had a permanent place to live in the community. 

Criminal Justice Drug Court and Reentry funded programs expand and enhance substance use 

disorder (SUD) treatment services to adults involved in the Criminal Justice system. They provide 

recovery support services, screening, assessment, case management, and program coordination to 

defendants/offenders to facilitate successful reentry to their communities. The desired outcome is 

to break the cycle of criminal behavior, alcohol and/or drug use, and incarceration or other penalties, 

and encourage stable work and home environments.

Family Treatment Drug Courts

The purpose of the Family Treatment Drug Court (FTDC) program is to expand substance use 

disorder (SUD) treatment services in existing family treatment drug courts, which use the family 

treatment drug court model in order to provide alcohol and drug treatment (including recovery 

support services, screening, assessment, case management, and program coordination) to parents 

with a SUD and/or co-occurring SUD and mental disorders, who have had a dependency petition 

filed against them or are at risk of such filing. FTDCs are expected to provide a coordinated, multisystem approach designed to combine the sanctioning power of treatment drug courts with effective 

treatment services promoting successful family preservation and reunification. FTDCs assist 

participants in reducing the rates of substance misuse, the severity of SUDs and co-occurring 
220

disorders, and decreasing out of home placements for children through family reunification and 

preservation. This should also decrease the number of parents or guardians whose parental rights 

have been or will be terminated.

Based on FY 2018 SAMHSA data, 1,062 clients received services through SAMHSA’s Family 

Drug Court Programs. Of these clients at six-month follow-up, 89 percent reported that they did 

not use alcohol or illegal drugs within the past 30 days, an increase of 25.9 percent. Additionally, 

there was a 7.3 percent increase from intake that had no involvement with the criminal justice 

system, a 42.8 percent increase of adult clients that were either employed or attending school, and 

39.2 percent increase in clients who had a permanent place to live in the community. 

Program Evaluation 

SAMHSA is conducting an evaluation of 17 grantees for which funding ended in September 2018. 

The final evaluation report is due April 2020. 

In FY 2018, the program served approximately 200 clients. At six month follow-up, 66.5 percent 

reported being employed or attending school, an increase of 4 percent over those reporting at intake; 

43.7 percent reported stability in housing, an increase of 1.5 percent over those reporting at intake; 

55.7 percent reported abstinence from substance use, an increase of 175 percent over those reporting 

at intake; and 96.8 percent reported no criminal justice involvement, an increase of 4.1 percent over 

those reporting at intake.

In FY 2019, SAMHSA funded 46 new drug court grants, including one Tribe/Tribal organization,

134 drug court grant continuations, and one contract. 

In FY 2020, SAMHSA plans to fund 25 new drug court grants, at least 5 will be Tribes/Tribal 

organizations, pending sufficient applications, 156 drug court grant continuations, and one contract. 

Criminal Justice Other/Offender Reentry Program

In addition to the drug court portfolio, SAMHSA supports the Offender Reentry Program (ORP) 

grants, as well as other criminal justice activities, such as a regional and national criminal justice 

technical support contract. Studies show that only about 10 percent of individuals involved with the 

criminal justice system who are in need of substance abuse treatment receive it as part of their 

justice system supervision. Approximately one-half of the institutional treatment provided is 

educational programming.89 During the past decade, awareness of the need for a continuum of care 

of services for adult offenders has grown as states and local communities have struggled with the 

increasing number of these individuals returning to the community after release from correctional 

confinement. ORP grants provide screening, assessment, comprehensive treatment, and recovery 

support services for diverse populations reentering the community from incarceration. ORP grant 

services include screening, comprehensive individual assessment for substance use and/or cooccurring mental disorders, program and case management, and alcohol and other drug treatment. 

Other supported services include wraparound and recovery support services such as recovery 

housing and peer recovery support designed to improve access and retention, drug testing for illicit 

substances, educational support, relapse prevention and long-term management, and HIV and viral 

hepatitis B and C testing conducted in accordance with state and local requirements. SAMHSA’s 

 89 Taxman FS, Perdoni ML, Harrison LD. (2007). Drug treatment services for adult offenders: The state of the state. 

Journal of Substance Abuse Treatment 32(3), 239-254. 
221

ORP grants are encouraged to use part of their annual award to provide medication-assisted 

treatment with FDA-approved medications.

Program Evaluation

Performance data show that these grant programs are effective in improving the lives of Offender 

Reentry Program court participants. Based on FY 2018 SAMHSA data, 1,415 clients received 

services through SAMHSA’s Offender Re-entry Programs. Of these clients at six-month followup, 64.5 percent reported that they did not use alcohol or illegal drugs within the past 30 days, an 

increase of 145 percent. Additionally, there was a 3.9 percent increase from intake that had no 

involvement with the criminal justice system, a 219.6 percent increase of adult clients that were 

either employed or attending school, and 669.2 percent increase in clients who had a permanent 

place to live in the community. 

In FY 2019, SAMHSA funded two new ORP grants and 32 ORP grant continuations. 

In FY 2020, SAMHSA plans to fund nine new ORP grants and 23 ORP grant continuations.

Funding History

Fiscal Year Amount

FY 2017 $74,000,000

FY 2018 $89,000,000

FY 2019 $89,000,000

FY 2020 $89,000,000

FY 2021 $89,000,000

Budget Request

The FY 2021 President’s Budget is $89.0 million, level with the FY 2020 Enacted level. SAMHSA 

intends to support 54 new drug court grants, 92 drug court continuation grants, and one contract. 

SAMHSA intends to fund 11 new and five continuation ORP grants, and one contract.
222

Outputs and Outcomes Table

Program: Criminal Justice - Drug Courts

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

1.2.72 Percentage of adult clients 

receiving services who were currently 

employed or engaged in productive 

activities (Outcome)

FY 2019: 66.1 %

Target: 50 %

(Target Exceeded)

66.1 % 66.1 % Maintain

1.2.73 Percentage of adult clients 

receiving services who had a permanent 

place to live in the community 

(Outcome)

FY 2019: 47.3 %

Target: 35 %

(Target Exceeded)

47.3 % 47.3 % Maintain

1.2.74 Percentage of adult clients 

receiving services who had no 

involvement with the criminal justice 

system (Outcome)

FY 2019: 92.8 %

Target: 85 %

(Target Exceeded)

92.8 % 92.8 % Maintain

1.2.76 Percentage of adult clients 

receiving services who had no past 

month substance use (Outcome)

FY 2019: 87.3 %

Target: 72 %

(Target Exceeded)

87.3 % 87.3 % Maintain

1.2.79 Number of adult clients served 

(Output)

FY 2019: 5,809

Target: 5,700

(Target Exceeded)

5,809 5,809 Maintain
223

Outputs and Outcomes Table

Program: Criminal Justice - Ex-Offender Re-Entry Program

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

1.2.80 Number of clients served 

(Outcome)

FY 2019: 1,661

Target: 1,300

(Target Exceeded)

1,661 1,661 Maintain

1.2.81 Percentage of clients who had 

no past month substance use 

(Outcome)

FY 2019: 62.2 %

Target: 70 %

(Target Not Met)

62.2 % 62.2 % Maintain

1.2.84 Percentage of clients receiving 

services who had no involvement 

with the criminal justice system 

(Outcome)

FY 2019: 86.8 %

Target: 93 %

(Target Not Met)

86.8 % 86.8 % Maintain
224

Outputs and Outcomes Table

Program: Treatment - Other Capacity

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

1.2.25 Percentage of adults receiving 

services who had no past month 

substance use (Outcome)

FY 2019: 73.9 %

Target: 67 %

(Target Exceeded)

70 % 70 % Maintain

1.2.26 Number of clients served 

(Output)

FY 2018: 30,175

Target: 20,310

(Target Exceeded)

32,000 35,000 +3,000

1.2.27 Percentage of adults receiving 

services who were currently 

employed or engaged in productive 

activities (Outcome)

FY 2019: 71.7 %

Target: 47 %

(Target Exceeded)

71.7 % 71.7 % Maintain

1.2.28 Percentage of adults receiving 

services who had a permanent place 

to live in the community (Outcome)

FY 2019: 62.6 %

Target: 47 %

(Target Exceeded)

50 % 50 % Maintain

1.2.29 The percentage of adults 

receiving services who had no 

involvement with the criminal justice 

system (Outcome)

FY 2019: 96.8 %

Target: 97.5 %

(Target Not Met)

96.8 % 96.8 % Maintain
225

Building Communities of Recovery (BCOR)

(Dollars in thousands) 

Programs of Regional & National Significance

FY 2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 2020

Building Communities of Recovery............................................ $6,000 $8,000 $8,000 $---

Authorizing Legislation Section 302 of the Comprehensive Addiction and Recovery Act of 2016

FY 2021 Authorization.................................................................................................... $5,000,000

Allocation Method..................................................................................................Grants/Contracts

Eligible Entities...................................Primary care, child welfare system, criminal justice system

Program Description and Accomplishments

Peer services play a vital role in assisting individuals in achieving recovery from substance use 

disorders. Recovery Community Organizations (RCOs) are central to the delivery of those services. 

In FY 2017, SAMHSA funded a new cohort of grant through the Comprehensive Addiction 

Recovery Act (CARA) Building Communities of Recovery (BCOR) program. The purpose of this 

program is to mobilize resources within and outside of the recovery community to increase the 

prevalence and quality of long-term recovery support from drug/alcohol addiction. These grants are 

intended to support the development, enhancement, expansion, and delivery of recovery support 

services (RSS) as well as promotion of and education about recovery. Programs are designed to be 

overseen by people in recovery from SUDs who reflect the community served. 

 

Grants support linkages between recovery networks and a variety of other organizations, systems, 

and communities, including primary care, other recovery networks, the child welfare system, the 

criminal justice system, housing services, and education/employment systems. Grantees will also 

work to reduce negative attitudes, discrimination, prejudice, and stigma around addiction and 

recovery. 

In FY 2018, SAMHSA funded 19 new grants, and provided continuation awards to five grants for 

a total of 24 BCOR grants. Moreover, these grantees received supplements for direct technical 

assistance. 

In FY 2019, SAMHSA funded five new BCOR awards and 23 BCOR continuation grants.

In FY 2020, SAMHSA plans to fund five new grants and 22 continuation grants.

Program Evaluation

These grants aim to mobilize resources within and outside of the recovery community and increase 

the prevalence and quality of long-term recovery support from substance use and addiction. The 

programs support the development, enhancement, expansion, and delivery of recovery support 

services (RSS) as well as the promotion of, and education about, recovery. They are managed and 

implemented primarily by people with lived experience and who are in recovery from substance 

use disorders and addiction and reflect the community being served. Grantees are using funds to 

1) build connections and linkages between recovery networks, between RCOs, and other Recovery 

Support Services (RSS); 2) reduce the stigma associated with addiction; and 3) conduct public 

education and outreach on issues relating to addiction and recovery. 
226

BCOR grant recipients have provided peer-related services to nearly 1,500 program participants 

achieving an almost 75 percent Intake Coverage Rate. At six-month follow-up participants have 

demonstrated a remarkable 137 percent improvement in obtaining education/employment and a 120 

percent significant increase in housing stability. Many BCOR grantees opted to pursue non-service 

oriented, or Best Practices, goals and objectives such as statewide networking and infrastructure 

development in their grant applications. Thus, these programs are reporting data to SPARS related 

to events, training activities, and the participants. In an effort to enhance program success and 

performance, as well as ensure long-term sustainability, the majority of BCOR grantees have a 

program evaluator.

Funding History

Fiscal Year Amount

FY 2017 $3,000,000

FY 2018 $5,000,000

FY 2019 $6,000,000

FY 2020 $8,000,000

FY 2021 $8,000,000

Budget Request

The FY 2021 President’s Budget is $8.0 million, level with the FY 2020 Enacted level. These funds 

will support 20 new grants and eight continuation grants for the Building Communities of Recovery 

program to develop, expand, and enhance recovery support services. 
227

Outputs and Outcomes Table

 Program: Building Communities for Recovery

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

1.2.80 Number of clients receiving 

recovery services (Output)

FY 2019: 343.0

Target: 300.0

(Target Exceeded)

343.0 343.0 Maintain

1.2.81 Clients who report not having 

stable housing at baseline who report 

having stable housing at six-month 

follow-up (Outcome)

FY 2019: 47.4

Target: 27.0

(Target Exceeded)

47.4 47.4 Maintain

1.2.82 Percent of clients who report 

not being employed (full-time or parttime) or in school at baseline who 

report having employment or being in 

school at follow-up (Outcome)

FY 2019: 64.5

Target: 36.0

(Target Exceeded)

64.5 64.5 Maintain
228

Minority Fellowship Program

(Dollars in thousands) 

Programs of Regional & National Significance

FY 2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 2020

SAT Minority Fellowship Program....................................... $4,789 $4,789 $4,789 $---

Authorizing Legislation ............................................Section 597 of the Public Health Service Act

FY 2021 Authorization.................................................................................................. $12,669,000

Allocation Method..................................................................................................Grants/Contracts

Eligible Entities.....Organizations that represent individuals obtaining post-baccalaureate training

(including for master’s and doctoral degrees) for mental and substance use disorder treatment 

professionals, including in the fields of psychiatry, nursing, social work, psychology, marriage 

and family therapy, mental health counseling, and substance use disorder and addiction 

counseling

Program Description and Accomplishments

SAMHSA’s Minority Fellowship Program (MFP) increases behavioral health practitioners’ 

knowledge of issues related to prevention, treatment, and recovery support for mental illness and 

drug/alcohol addiction among racial and ethnic minority populations. The mental health and 

substance use needs of racial and ethnic minority communities in the United States have been 

historically underserved due to a variety of factors. These include a limited number of postbaccalaureate (including master’s and doctoral level) trained professionals in psychiatry, 

psychology, nursing, social work, marriage and family therapy, mental health counseling, and 

substance use and addictions counseling who are equipped with the skills and cultural competencies 

needed to deliver effective services. Since its start in 1973, the program has helped to enhance 

services for racial and ethnic minority communities through specialized training of mental health 

professionals in psychiatry, nursing, social work, and psychology. In 2006, the program expanded 

to include marriage and family therapists and later added professional counselors specializing in 

addiction. In FY 2018, an additional program was created to address specialized training in 

addiction psychiatry, psychology, and addiction medicine. Professional guilds receive 

competitively awarded grants, and then competitively award the stipends to graduate and postgraduate students pursuing a degree in corresponding professional fields. 

This program is jointly administered by the Center for Substance Abuse Treatment (CSAT), the 

Center for Substance Abuse Prevention (CSAP), and the Center for Mental Health Services 

(CMHS) at SAMHSA. CSAT also funded one additional grant for to support the program that 

specializes in fellowships for addiction psychiatry, psychology, and addiction medicine.

Combined, these programs will support fellowships for hundreds of students as well as support 

additional training through webinars on culturally appropriate services to thousands of students.

In FY 2018, SAMHSA funded eight new MFP grants and one MFP technical assistance contract.

In FY 2019, SAMHSA funded eight continuation grants and one contract. 

In FY 2020, SAMHSA funded eight continuation grants and one contract.
229

Funding History

Fiscal Year Amount

FY 2017 $3,539,000

FY 2018 $4,539,000

FY 2019 $4,789,000

FY 2020 $4,789,000

FY 2021 $4,789,000

Budget Request

The FY 2021 President’s Budget is $4.8 million, level with the FY 2020 Enacted level. SAMHSA 

will continue to fund eight grants.
230

Addiction Technology Transfer Centers

(Dollars in thousands) 

Programs of Regional & National Significance

FY 2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 2020

Addiction Technology Transfer Centers............................ $9,046 $9,046 $9,046 $---

Authorizing Legislation ............................................Section 509 of the Public Health Service Act

FY 2021 Authorization................................................................................................ $333,806,000

Allocation Method....................................Competitive Grants/Contracts/Cooperative Agreements

Eligible Entities....................................................Domestic Public and Private Non-Profit Entities

Program Description and Accomplishments

Misuse of, and addiction to alcohol, tobacco, and illicit drugs cost Americans more than 

$700 billion a year in increased healthcare costs, crime, and lost productivity.90, 91 Recently, the 

nation’s attention has been on the increase misuse of opioids. The majority of drug overdose deaths 

(more than six out of ten) involved an opioid.92 Alcohol/other drug addiction is treatable and 

research has led to development of medications and evidence-based psychosocial interventions that 

help people achieve recovery and resume productive lives. One critical need is to help recruit, train, 

and support treatment providers in the use of evidence-based practices. 

The purpose of the Technology Transfer Centers is to develop and strengthen the specialized 

behavioral healthcare and primary healthcare workforce that provides prevention, treatment and 

recovery support services for substance use disorder (SUD) and mental illness. The program’s 

mission is to help people and organizations to incorporate effective evidence based practices into 

substance use disorder and mental health prevention, treatment and recovery services. Together the 

Network serves the 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and 

the Pacific Islands of Guam, American Samoa, Palau, the Marshall Islands, Micronesia, and the 

Mariana Islands.

After 25 years of conducting training workshops, translating research into bite-size pieces for 

curricula or stand-alone products, and creating opportunities for performance feedback to enhance 

skill development, the Addiction Technology Transfer Centers (ATTCs) are improving and 

updating their programs to offer novel training and technical assistance (TA) options that include 

multiple learning components in new delivery formats focused on changing practices.

In 2017 SAMHSA funded a new five-year cycle of the ATTC program (2017-2022) which is 

comprised of ten regional centers (one in each HHS Region), one coordinating center, and two 

national focus-area centers: the National American Indian and Alaska Native ATTC and the 

National Hispanic and Latino ATTC. SAMHSA recently completed the continuation application 

for these 13 centers (FY 2019) which are entering their third year of their current program cycle. 

 90 National Institute for Drugs and Alcohol. (2015). Trends and Statistics. Retrieved from NIH/NIDA: 

http://www.drugabuse.gov/related-topics/trends-statistics 91 National Institute for Drugs and Alcohol. (2015). Trends and Statistics. Retrieved from NIH/NIDA: 

http://www.drugabuse.gov/related-topics/trends-statistics

92 Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015. 

MMWR Morb Mortal Wkly Rep. ePub: 16 December 2016
231

To date, under the current cycle (2017-2022), the 13 ATTCs combined have delivered training and 

technical assistance for over 43,000 healthcare professionals and paraprofessionals who deliver 

services for patients with substance use disorders. 

In FY 2018, the ATTC program continued with its mission of helping people and organizations to 

incorporate effective practices into substance use disorder treatment and recovery services. 

Together the 13 centers coordinated several webinars and learning collaborative series, developed 

several products and online trainings to address the opioid crisis and provided consultation to 

professional and paraprofessional throughout the US and its territories.

Program Evaluation

In FY 2019, SAMHSA is funding a two-year grant to evaluate the ATTC program. The ATTC 

evaluation will start on September 30, 2019 and it will be completed by September 29, 2021.

In FY 2020, SAMHSA will continue to fund the ATTC program (year 4 of the current cycle) and 

the network will continue to focus on delivering training and technical assistance for providers who 

are serving patients with substance use disorders by improving their capacity and understanding of 

evidence based practices, especially practices that are effective in combating the opioid crisis.

Building on a rich history, the ATTC Network continuously strives to improve the quality of 

addictions treatment and recovery services by facilitating alliances among front line counselors, 

treatment and recovery services agency administrators, faith-based organizations, policy makers, 

the health and mental health communities, consumers and other stakeholders. By connecting these 

providers to the latest research and information through activities such as skills training, academic 

education, online and distance education, conferences, workshops, and publications, the ATTC 

Network continues to respond to the emerging needs of the field.
232

Funding History

Fiscal Year Amount

FY 2017 $9,046,000

FY 2018 $9,046,000

FY 2019 $9,046,000

FY 2020 $9,046,000

FY 2021 $9,046,000

Budget Request

The FY 2021 President’s Budget is $9.0 million, level with the FY 2020 Enacted level. SAMHSA 

plans to fund 12 continuation grants. Funding will allow the ATTC grantees to disseminate 

evidence-based, promising practices to addiction treatment and recovery professionals, public 

health and mental health personnel, institutional and community corrections professionals, and 

other related disciplines. 
233

Improving Access to Overdose Treatment

(Dollars in thousands)

Programs of Regional & National Significance

FY 2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 2020

Improving Access to Overdose Treatment........................ $1,000 $1,000 $1,000 $---

Authorizing Legislation Section 302 of the Comprehensive Addiction and Recovery Act of 2016

FY 2021 Authorization.................................................................................................. $12,000,000

Allocation Method..................................................................................................Grants/Contracts

Eligible Entities...................................Primary care, child welfare system, criminal justice system

Program Description and Accomplishments

Drug overdose deaths and opioid-involved deaths continue to increase in the United States. In 2018, 

there were 67,367 drug overdose deaths in the United States. Synthetic opioids are the main driver 

of drug overdose deaths. SAMHSA’s Opioid Overdose Prevention Toolkit helps reduce the number 

of opioid-related overdose deaths and adverse events. The Improving Access to Overdose 

Treatment (CARA) grant program utilizes this toolkit and other resources to help grantees train and 

provide resources to health care providers and pharmacists on the prescribing of drugs or devices 

approved or cleared under the Federal Food, Drug, and Cosmetic Act for emergency treatment of 

known or suspected opioid overdose. 

Further, the Improving Access to Overdose Treatment (CARA) grant program addresses the opioid 

crisis by increasing access to treatment, reducing unmet treatment need, and reducing opioid 

overdose related deaths through the provision of prevention, treatment, and recovery activities for 

opioid use disorder (including prescription opioids as well as illicit drugs such as heroin). 

SAMHSA awarded one (1) Improving Access to Overdose Treatment (CARA) grant in FY 2017. 

The grantee partners with other prescribers at the community level to develop best practices for 

prescribing and co-prescribing FDA-approved overdose reversal drugs. After developing best 

practices, the grantee will train other prescribers in key community sectors as well as individuals 

who support persons at high risk for overdose. This grant program also ensures the grantee 

establishes protocols to connect patients who have experienced a drug overdose with appropriate 

treatment, including medication-assisted treatment and appropriate counseling and behavioral 

therapies.

In FY 2018, SAMHSA awarded five Improving Access to Overdose Treatment (CARA) grants. 

In FY 2019, SAMHSA funded five continuation grants.

In FY 2020, SAMHSA plans to fund five continuation grants.

Program Evaluation

In FY 2018, 15 programs or best practices were developed for prescribing or co-prescribing FDAapproved opioid-overdose reversal drugs or devices. This number of programs are expected to be 

maintained annually through FY 2021.
234

In FY 2018, 1,341 individuals were trained on prescribing FDA-approved opioid-overdose reversal 

drugs or devices for emergency treatment of known or suspected opioid overdose. This number of 

trained prescribers is expected to be maintained through FY2021. 

Funding History

Fiscal Year Amount

FY 2017 $1,000,000

FY 2018 $1,000,000

FY 2019 $1,000,000

FY 2020 $1,000,000

FY 2021 $1,000,000

Budget Request

The FY 2021 President’s Budget is $1.0 million, level with the FY 2020 Enacted level. SAMHSA 

will support five grants to continue increasing access to treatment, reducing unmet treatment need, 

and reducing opioid overdose related deaths through the provision of prevention, treatment, and 

recovery activities for opioid use disorder.
235

Outputs and Outcomes Table

Program: Improving Access to Overdose Treatment

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

5.2.0 Number of programs or best 

practices developed for prescribing or 

co-prescribing FDA-approved opioidoverdose reversal drugs or devices. 

(Output)

FY 2018: 15.0

Target: 15.0

(Baseline)

15.0 15.0 Maintain

5.2.1 Number trained on prescribing 

FDA-approved opioid-overdose 

reversal drugs or devices for 

emergency treatment of known or 

suspected opioid overdose. (Output)

FY 2018: 1,341.0

Target: 1,341.0

(Baseline)

1,341.0 1,341.0 Maintain
236

First Responder Training for Opioid Overdose Reversal Drugs

(Dollars in thousands) 

Programs of Regional & National Significance

FY 2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 2020

First Responder Training (CARA)............................................ $36,000 $41,000 $41,000 $---

First Responder Training (non-add)................................. 18,000 18,000 18,000 ---

Rural Set-Aside (non-add).................................................... 18,000 23,000 23,000 ---

Authorizing Legislation ....................................................................... Section 546 of the PHS Act

FY 2021 Authorization ................................................................................................ $36,000,000

Allocation Method............................................................................................Competitive Grants

Eligible entities.................................States, local government entities, federally recognized 

 American Indian/Alaska Native tribe or tribal organizations

Program Description and Accomplishments

Drug overdose deaths take too many lives. Increased use of overdose reversal drugs can help reduce 

the number of overdose deaths.

The purpose of this program, authorized under Section 202 of CARA, is to help first responders 

and members of other key community sectors to administer a drug or device approved or cleared 

under the Federal Food, Drug, and Cosmetic Act for emergency treatment of known or suspected 

opioid overdose. Grantees train and provide resources to first responders and members of other 

key community sectors at the state, tribal, and local governmental levels on carrying and 

administering a drug or device approved or cleared under the Federal Food, Drug, and Cosmetic 

Act for emergency treatment of known or suspected opioid overdose. Grantees also establish 

processes, protocols, and mechanisms for referral to appropriate treatment and recovery 

communities. This program includes a broader eligibility than state-based Grants to Prevent Opioid 

Overdose-related Death program. The program allows for much needed services to reach local and 

tribal areas. The First Responder Training program also includes a set-aside to address the critical 

needs of rural populations.

Training, technical assistance, and evaluation activities are also being supported to assist grantees, 

determine best practices, and assess program outcomes. In FY 2018, SAMHSA funded 27 new 

grants under the Comprehensive Addiction and Recovery Act (CARA). In FY 2019, Congress 

appropriated funding for this program under Substance Abuse Treatment to continue to support the 

continuation grants.

Program Evaluation

In FY 2018, 30,313 Naloxone (or other FDA-approved) kits were distributed. Approximately the 

same number of kits will be distributed in FY 2019. Based upon estimates provided from grantees, 

approximately the same number of kits will be distributed in FY 2020 and 2021.

In FY 2018, 5,983 first responders were trained on how to administer Naloxone (or other FDA 

approved drug or device). Approximately the same number of first responders will be trained in FY 

2019 through FY 2021.
237

In FY 2018, SAMHSA awarded 14 new grants and 21 continuation grants.

In FY 2019, SAMHSA funded 20 new grants and 34 continuation grants.

In FY 2020, SAMHSA anticipates funding 58 continuation grants and four new grants.

Funding History*

Fiscal Year Amount

FY 2017 $12,000,000

FY 2018 $36,000,000

FY 2019 $36,000,000

FY 2020 $41,000,000

FY 2021 $41,000,000

*

This activity was funded under the Substance Abuse Prevention appropriation in 2017 and 2018.

Budget Request

The FY 2021 President’s Budget is $41.0 million, level with the FY 2020 Enacted level. SAMHSA 

plans to fund 14 new First Responder Training grants. SAMHSA will continue to provide grants 

to key community sectors at the state, tribal, and local governmental levels on carrying and 

administering a drug or device approved and cleared under the Federal Food, Drug, and Cosmetic 

Act for emergency treatment of known or suspected opioid overdose. The First Responders 

Program aims to decrease opioid overdose mortality and prevalence of opioid use disorders in rural 

communities. SAMHSA will also continue to support grants to rural public and non-profit fire and 

emergency medical services agencies to recruit and train personnel and acquire emergency medical 

services equipment as required by the Occupational Safety and Health Administration. 
238

Outputs and Outcomes Table

Program: First Responder Training-CARA

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

5.0.1 Number of FDA-approved 

overdose reversing medication kits 

(Output)

FY 2018: 30,313.0

Target: 30,313.0

(Baseline)

30,313.0 30,313.0 Maintain

5.1.1 Number of first responders 

trained how to administer FDAapproved overdose reversing 

medication kits (Output)

FY 2018: 5,983.0

Target: 5,983.0

(Baseline)

5,983.0 5,983.0 Maintain
239

Grants to Prevent Prescription Drug/Opioid Overdose Related Deaths

(Dollars in thousands) 

Programs of Regional & National Significance

FY 2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 2020

Grants to Prevent Prescription Drug/Opioid Overdose-Related 

Deaths. $12,000 $12,000 $12,000 $---

Authorizing Legislation ............................................ Section 516 and Section 546 of the PHS Act

FY 2021 Authorization.................................................................................................. $12,000,000

Allocation Method............................................................................ Competitive Grants, Contracts

Eligible Entities.......................................... States, local government entities, federally recognized 

 American Indian/Alaska Native tribe or tribal organizations

Program Description and Accomplishments

Opioid overdose is a significant contributor to accidental deaths among those who use, misuse, or 

abuse illicit and prescription opioids (including synthetics such as fentanyl).93 Opioids include 

illegal drugs such as heroin, as well as prescription medications used to treat pain. These 

prescription medications include morphine, codeine, methadone, oxycodone (OxyContin, 

Percodan, Percocet), hydrocodone (Vicodin, Lortab, Norco), fentanyl (Duragesic, Fentora), 

hydromorphone (Dilaudid, Exalgo), and buprenorphine (Subutex, Suboxone). Opioids bind to 

specific receptors in the brain, spinal cord, and gastrointestinal tract and reduce the body’s 

perception of pain. As opioids reduce pain, they induce a slight sense of euphoria, which can lead 

to overuse. 

In 2018, SAMHSA revised its Opioid Overdose Prevention Toolkit, a resource which has been vital

in helping reduce the number of opioid-related overdose deaths and adverse events. The Toolkit 

was the first federal resource that includes safety and prevention information for individuals at risk 

for overdose. The toolkit provides information on how to recognize and respond appropriately to 

overdose, identifies specific drug-use behaviors to avoid, and describes the role of overdose 

reversing drugs in preventing death from an overdose. A growing evidence base suggests that 

overdose reversal drugs are a cost-effective method to reducing opioid overdose deaths.

As the rates of prescription drug abuse, heroin abuse, illicit synthetic opioid abuse, overdoses, and 

opioid-related overdose deaths increase, communities are searching for ways to reduce the death 

rate from opioid-related overdoses. 

SAMHSA awarded 13 grants to states for the Grants to Prevent Prescription Drug and Opioid 

Overdose-related Deaths program, which helps states identify communities of high need and 

provide education, training, and resources necessary to meet their specific needs. The grant funds 

can be used for purchasing overdose reversing drugs, equipping first responders with them, 

providing training on their use, developing other overdose-related death prevention strategies, and

providing materials to assemble and disseminate overdose kits. These grantees are also required to 

develop a dissemination plan and a training course tailored to meet the needs of first responders in 

 93 National Institute on Drug Use (NIDA). America’s Addiction to Opioids: Heroin and Prescription Drug Abuse. 

(2014) Available from URL: http://www.drugabuse.gov/about-nida/legislative-activities/testimony-tocongress/2015/americas-addiction-to-opioids-heroin-prescription-drug-abuse#_ftnref4
240

their communities. The course uses SAMHSA’s Opioid Overdose Prevention Toolkit as a guide 

and includes a comprehensive prevention program that will focus on prevention, treatment, and 

recovery services in order to decrease the likelihood of drug overdose recurrence. 

In FY 2020, SAMHSA anticipates funding 12 continuation awards.

Program Evaluation

In FY 2018, 44,348 Naloxone (or other FDA-approved) kits were distributed. This number exceed 

the previous target of 20,000 kits. SAMHSA estimates that that the same number of kits (44,348) 

will continue to be distributed in each of FY 2019, FY 2020, and FY 2021.

In FY 2018, 20,036 laypersons were trained how to administer Naloxone (or other FDA approved 

drug or device). This number exceeded the target of 2,000. SAMHSA estimates that this number 

of people will also be served in each of FY 2019, FY 2020, and FY 2021.

Funding History*

Fiscal Year Amount

FY 2017 $12,000,000

FY 2018 $12,000,000

FY 2019 $12,000,000

FY 2020 $12,000,000

FY 2021 $12,000,000

1*

This activity was funded under the SAP appropriation in FY 2017 and FY 2018.

Budget Request

The FY 2021 President’s Budget is $12.0 million, level with the FY 2020 Enacted level. This 

funding will provide 14 new grants to states to reduce the number of opioid overdose-related deaths. 

Funding will help states purchase overdose reversing drugs, equip first responders in high-risk 

communities, support education on the use of naloxone and other overdose-related death prevention 

strategies, provide the necessary materials to assemble overdose kits, and cover expenses incurred 

from dissemination efforts.
241

Outputs and Outcomes Table

Program: PDO/Naloxone

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

5.0 Number of Naloxone (or other 

FDA-approved) kits distributed 

(Output)

FY 2018: 44,348.0

Target: 20,000.0

(Target Exceeded)

44,348.0 44,348.0 Maintain

5.1 Number of lay persons trained 

how to administer Naloxone (or 

other FDA approved drug or 

device). (Output)

FY 2018: 20,036.0

Target: 2,000.0

(Target Exceeded)

20,036.0 20,036.0 Maintain
242

 Grants to Develop Curricula for DATA Act Waivers 

(Dollars in thousands)

Programs of Regional & National Significance

FY 2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 2020

Grants to Develop Curricula for DATA Act Waivers......... $--- $--- $4,000 $4,000

Authorizing Legislation .......... Section 3203 of the SUPPORT for Patients and Communities Act

FY 2021 Authorization.................................................................................................... $4,000,000

Allocation Method..............................................................................................Competitive Grants

Eligible Entities........................................................Medical school, physician assistant 

schools, and schools of nursing (programs for nurse practitioners will be focus)

Program Description and Accomplishments

The purpose of this new program, which is authorized by section 3203 of the SUPPORT for Patients 

and Communities Act, is to expand access to substance use disorder treatment by supporting grants 

to accredited schools of allopathic medicine or osteopathic medicine and teaching hospitals located 

in the United States to support the development of curricula that meet the requirements the 

Controlled Substances Act with respect to the treatment and management of opiate-dependent 

patients. 

Funding History

Fiscal Year Amount

FY 2017 ---

FY 2018 ---

FY 2019 ---

FY 2020 ---

FY 2021 $4,000,000

Budget Request

The FY 2021 President’s Budget is $4.0 million, an increase of $4.0 million from the FY 2020 

Enacted level. This funding will support 117 grants.
243

 Peer Support Technical Assistance Center 

(Dollars in thousands)

Programs of Regional & National Significance

FY 2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 2020

Peer Support TA Center.................................................. $--- $1,000 $1,000 $---

Authorizing Legislation...Section 7152 of the SUPPORT for Patients and Communities Act (Sec. 

547A of the PHS Act)

FY 2021 Authorization.................................................................................................... $1,000,000

Allocation Method..............................................................................................Competitive Grants

Eligible Entities......................................................................Recovery Community Organizations

Program Description and Accomplishments

The purpose of this new program, which is authorized by section 7152 of the SUPPORT for Patients 

and Communities Act (P.L. 115-271), is to provide funding for the creation of a National Peer-Run 

Training and Technical Assistance Center for Addiction Recovery Support, or the Center. The 

Center provides technical assistance and support to recovery community organizations and peer 

support networks. The technical assistance is related to training, translation and interpretation 

services, data collection, capacity building, and evaluation and improvement of the effectiveness of 

such services provided by recovery community organizations.

Funding History

Fiscal Year Amount

FY 2017 ---

FY 2018 ---

FY 2019 ---

FY 2020 $1,000,000

FY 2021 $1,000,000

Budget Request

The FY 2021 President’s Budget is $1.0 million, level with the FY 2020 Enacted level.
244

Outputs and Outcomes Table

Program: Peer Support Technical Assistance Center

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020 

Target

FY 2021

Target

FY 2021 

Target

+/-

FY 2020

Target

TBD. Number of people train for the 

support of the recovery community 

organizations and peer support 

networks. (Output)

FY 2020: Result Expected 

December 31, 2021

Target: Set Baseline

(Pending)

Maintain 

Baseline

Maintain 

Baseline

Maintain

TBD. Number trained on technical 

assistance, translation and 

interpretation services, data collection, 

capacity building, and evaluation and 

improvement of the effectiveness of 

such services provided by recovery 

community organizations. (Output)

FY 2020: Result Expected 

December 31, 2021

Target: Set Baseline

(Pending)

Maintain 

Baseline

Maintain 

Baseline

Maintain
245

Emergency Department Alternatives to Opioids 

(Dollars in thousands)

Programs of Regional & National Significance

FY 2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 2020

Emergency Department Alternatives to Opioids......... $--- $5,000 $5,000 $---

Authorizing Legislation ........... Section 7091 of the SUPPORT for Patients and Communities Act

FY 2021 Authorization.................................................................................................... $5,000,000

Allocation Method..............................................................................................Competitive Grants

Eligible Entities.................................................................. Hospitals and Emergency Departments

Program Description and Accomplishments

The purpose of this new program, which is authorized by section 7091 of the SUPPORT for Patients 

and Communities Act (P.L. 115-271) is to provide funding to hospitals and emergency departments, 

including freestanding emergency departments, to develop, implement, enhance, or study 

alternative pain management protocols and treatments that limit the use and prescribing of opioids 

in emergency departments. In addition, these funds will be used to target common painful 

conditions, train providers and other hospital personnel, and provide alternatives to opioids for

patients with painful conditions.

Funding History

Fiscal Year Amount

FY 2017 ---

FY 2018 ---

FY 2019 ---

FY 2020 $5,000,000

FY 2021 $5,000,000

Budget Request

The FY 2021 President’s Budget level is $5.0 million, level with the FY 2020 Enacted.
246

Outputs and Outcomes Table

Program: Emergency Department Alternative to Opioids

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020 

Target

FY 2021

Target

FY 2021 

Target

+/-

FY 2020

Target

TBD. Number of people train for the 

providers and other hospital personnel. 

(Output)

FY 2020: Result Expected 

December 31, 2021

Target: Set Baseline

(Pending)

Maintain 

Baseline

Maintain 

Baseline

Maintain

TBD. Number trained on alternative pain 

management protocols and treatments that 

limit the use and prescribing of opioids in 

emergency departments. (Output)

FY 2020: Result Expected 

December 31, 2021

Target: Set Baseline

(Pending)

Maintain 

Baseline

Maintain 

Baseline

Maintain
247

Treatment, Recovery, and Workforce Support

(Dollars in thousands)

Programs of Regional & National Significance

FY 2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 2020

Treatment, Recovery, and Workforce Support......... $--- $4,000 $4,000 $---

Authorizing Legislation .......... Section 7183 of the SUPPORT for Patients and Communities Act

FY 2021 Authorization.................................................................................................... $4,000,000

Allocation Method..............................................................................................Competitive Grants

Eligible Entities....... SSAs, Tribes and Tribal Organizations, Entities that offer treatment or other 

services following a drug overdose (e.g., emergency departments)

Program Description and Accomplishments

The purpose of this new program, which is authorized by section 7081 of the SUPPORT for Patients 

and Communities Act, is to support the implementation of voluntary programs for care and 

treatment of individuals after a drug overdose, as appropriate, which may include utilizing recovery 

coaches, establishing policies and procedures that address the provision overdose reversal 

medication and FDA-approved medications to treat substance use disorders, and establishing 

integrated models of care for individuals who have experienced a non-fatal drug overdose. 

SAMHSA is directed, in consultation with the Secretary of Labor, to award competitive grants to 

entities to carry out evidence- based programs to support individuals in substance use disorder 

treatment and recovery to live independently and participate in the workforce.

Funding History

Fiscal Year Amount

FY 2017 ---

FY 2018 ---

FY 2019 ---

FY 2020 $4,000,000

FY 2021 $4,000,000

Budget Request

The FY 2021 President’s Budget is $4.0 million, level with the FY 2020 Enacted level.
248

Outputs and Outcomes Table

Program: Treatment, Recovery, and Workforce Support

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020 

Target

FY 2021

Target

FY 2021 

Target

+/-

FY 2020

Target

TBD. Number of people participate in 

the workforce. (Output)

FY 2020: Result Expected 

December 31, 2021

Target: Set Baseline

(Pending)

Maintain 

Baseline

Maintain 

Baseline

Maintain

TBD. Number of people received 

treatment and recovery to live 

independently. (Output)

FY 2020: Result Expected 

December 31, 2021

Target: Set Baseline

(Pending)

Maintain 

Baseline

Maintain 

Baseline

Maintain
249

SAMHSA/Substance Abuse Treatment

PRNS Mechanism Table Summary

(Dollars in thousands)

Program Activity

FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget 

No. Amount No. Amount No. Amount

Grants/Cooperative Agreements:

 Continuations................................................... 562 $316,595 803 $391,531 692 $281,472

 New/Competing............................................... 177 105,068 76 37,791 33 23,150 

Supplements....................................................... --- 6,354 --- 5,574 --- 3,920 

 

Subtotal........................................................... 739 428,017 879 434,896 725 308,542

Contracts:

 Continuations................................................... 10 27,295 4 26,231 5 24,432 

 New/Competing............................................... 2 3,218 2 18,549 --- 31,703 

 

Subtotal........................................................... 12 30,513 6 44,781 5 56,135

Total, Substance Abuse Treatment 751 $458,530 885 $479,677 730 $364,677
250

SAMHSA/Substance Abuse Treatment

PRNS Mechanism Table by Program, Project, and Activity

(Dollars in thousands)

FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

Programs of Regional & National Significance No. Amount No. Amount No. Amount

Capacity:

Opioid Treatment Programs/Regulatory Activities

 Grants

Continuations............................................................................. 29 $4,391 30 $6,407 2 $2,400

New/Competing......................................................................... 1 2,000 --- --- --- ---

Supplements*............................................................................. --- --- --- --- --- ---

Subtotal.................................................................................... 30 6,260 30 6,407 2 2,400

 Contracts

Continuations............................................................................. 2 2,340 1 1,196 2 2,522

New/Competing......................................................................... 2 124 1 1,120 --- 3,802

Subtotal.................................................................................... 4 2,464 2 2,317 2 6,324

Total, Opioid Treatment Programs/Regulatory Activities 34 8,724 32 8,724 4 8,724

Screening, Brief Intervention and Referral to Treatment 

 Grants

Continuations............................................................................. 8 11,850 21 25,773 --- ---

New/Competing......................................................................... 13 12,468 --- --- --- ---

Supplements*............................................................................. 8 200 8 200 --- ---

Subtotal.................................................................................... 21 24,518 21 25,973 --- ---

 Contracts

Continuations............................................................................. 1 1,789 --- 1,802 --- ---

New/Competing......................................................................... --- 1,959 --- 2,226 --- ---

Subtotal.................................................................................... 1 3,748 --- 4,027 --- ---

Total, Screening, Brief Intervention and Referral to 

Treatment 22 27,854 21 30,000 --- ---

Targeted Capacity Expansion

 Grants

Continuations............................................................................. 6 69,383 183 89,872 26 9,635

New/Competing......................................................................... 24 25,114 10 4,736 1 50

Supplements*............................................................................. 4 250 --- 100 --- ---

Subtotal.................................................................................... 30 94,747 193 94,709 27 9,685

 Contracts

Continuations............................................................................. --- 5,253 --- 5,283 --- 678

New/Competing......................................................................... --- 192 --- 201 --- 829

Supplements*............................................................................. --- --- --- --- --- ---

Subtotal.................................................................................... --- 5,445 --- 5,483 --- 1,507

Total, Targeted Capacity Expansion 30 100,192 193 100,192 27 11,192

Subtotal, Capacity 86 136,770 246 138,916 31 19,916
251

SAMHSA/Substance Abuse Treatment

PRNS Mechanism Table by Program, Project, and Activity

(Dollars in thousands)

FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

Programs of Regional & National Significance No. Amount No. Amount No. Amount

Pregnant and Postpartum Women 

 Grants

Continuations............................................................................. 42 24,692 42 22,888 42 23,657

New/Competing......................................................................... 3 1,668 --- --- --- ---

Supplements*............................................................................. 45 1,125 --- 1,000 --- 1,025

Subtotal.................................................................................... 45 27,486 42 23,888 42 24,682

 Contracts

Continuations............................................................................. --- 1,569 --- 1,673 --- 1,889

New/Competing......................................................................... --- 671 --- 6,370 --- 5,360

Supplements*............................................................................. --- 205 --- --- --- ---

Subtotal.................................................................................... --- 2,445 --- 8,043 --- 7,249

Total, Pregnant and Postpartum Women 45 29,931 42 31,931 42 31,931

Recovery Community Services Program

 Grants

Continuations............................................................................. 13 1,949 3 450 9 1,350

New/Competing......................................................................... --- 32 9 1,761 --- 500

Supplements **......................................................................... 13 325 --- 75 --- ---

Subtotal.................................................................................... 13 2,306 12 2,286 9 1,850

 Contracts

Continuations............................................................................. --- 128 --- 128 --- 144

New/Competing......................................................................... --- 1 --- 20 --- 440

Subtotal.................................................................................... --- 128 --- 148 --- 584

Total, Recovery Community Services Program 13 2,434 12 2,434 9 2,434

Children and Families

 Grants

Continuations............................................................................. 42 24,803 46 26,955 35 18,454

New/Competing......................................................................... 4 1,628 --- --- --- 7,500

Supplements *............................................................................ --- 300 --- 275 --- ---

Subtotal.................................................................................... 46 26,730 46 27,230 35 25,954

 Contracts

Continuations............................................................................. 1 2,866 1 3,016 --- 3,216

New/Competing......................................................................... --- 9 --- -641 --- 435

Subtotal.................................................................................... 1 2,875 1 2,375 --- 3,651

Total, Children and Families 47 29,605 47 29,605 35 29,605

Subtotal, Capacity 105 61,970 101 63,970 86 63,970
252

SAMHSA/Substance Abuse Treatment

PRNS Mechanism Table by Program, Project, and Activity

(Dollars in thousands)

FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's

Budget

Programs of Regional & National Significance No. Amount No. Amount No. Amount

Treatment Systems for Homeless 

 Grants

Continuations............................................................................. 66 24,240 72 28,365 72 27,974

New/Competing......................................................................... 22 8,862 14 4,704 --- ---

Supplements *............................................................................ 88 800 39 720 22 520

Subtotal.................................................................................... 88 33,902 86 33,789 72 28,494

 Contracts

Continuations............................................................................. 1 2,484 --- 1,911 1 2,958

New/Competing......................................................................... --- --- 1 686 --- 4,935

Subtotal.................................................................................... 1 2,484 1 2,597 1 7,892

Total, Treatment Systems for Homeless 89 36,386 87 36,386 73 36,386

Minority AIDS 

 Grants

Continuations............................................................................. 95 46,668 120 59,743 120 59,326

New/Competing......................................................................... 25 13,069 --- --- --- ---

Supplements *............................................................................ 92 2,300 --- 2,375 --- 2,375

Subtotal.................................................................................... 120 62,037 120 62,118 120 61,701

 Contracts

Continuations............................................................................. 1 3,438 --- 3,293 --- 3,765

New/Competing......................................................................... --- 95 --- 159 --- 104

Subtotal.................................................................................... 1 3,533 --- 3,452 --- 3,869

Total, Minority AIDS 121 65,570 120 65,570 120 65,570

Criminal Justice Activities

 Grants

Continuations............................................................................. 166 59,888 176 68,160 197 81,768

New/Competing......................................................................... 60 22,720 43 14,400 --- ---

Supplements *............................................................................ --- --- --- --- --- ---

Subtotal.................................................................................... 226 82,608 219 82,560 197 81,768

 Contracts

Continuations............................................................................. 3 6,229 2 6,180 2 7,024

New/Competing......................................................................... --- 162 --- 260 --- 209

Subtotal.................................................................................... 3 6,392 2 6,440 2 7,232

Total, Criminal Justice Activities 229 89,000 221 89,000 199 89,000

Improving Access to Overdose Treatment

 Grants

Continuations............................................................................. 5 843 5 909 5 913

New/Competing......................................................................... --- --- --- --- --- ---

Supplements *............................................................................ --- 104 --- 104 --- ---

Subtotal.................................................................................... 5 947 5 1,013 5 913

 Contracts

Continuations............................................................................. --- 52 --- 52 --- 59

New/Competing......................................................................... --- --- --- -65 --- 28

Subtotal.................................................................................... --- 52 --- -13 --- 87

Total, IATOT 5 1,000 5 1,000 5 1,000

Subtotal, Capacity 444 191,956 433 191,956 397 191,956
253

SAMHSA/Substance Abuse Treatment

PRNS Mechanism Table by Program, Project, and Activity

(Dollars in thousands)

FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

Programs of Regional & National Significance No. Amount No. Amount No. Amount

Building Communities of Recovery

 Grants

Continuations............................................................................. 23 4,290 22 4,469 8 1,521

New/Competing......................................................................... 5 745 --- 2,692 20 4,100

Supplements *............................................................................ 26 650 --- 425 --- ---

Subtotal.................................................................................... 28 5,685 22 7,587 28 5,621

 Contracts

Continuations............................................................................. --- 315 --- 413 --- 469

New/Competing......................................................................... --- --- --- --- --- 1910

Subtotal.................................................................................... --- 315 --- 413 --- 2,379

Total, Building Communities of Recovery 28 6,000 22 8,000 28 8,000

Grants to Prevent Prescription Drug/Opioid OverdoesRelated Deaths

 Grants

Continuations............................................................................. 12 11,700 12 11,253 --- 689

New/Competing......................................................................... --- --- --- --- 12 11,000

Supplements *............................................................................ --- 300 --- 300 --- ---

Subtotal.................................................................................... 12 12,000 12 11,553 12 11,689

 Contracts

Continuations............................................................................. --- --- --- --- --- ---

New/Competing......................................................................... --- --- --- 447 --- 311

Subtotal.................................................................................... --- --- --- 447 --- 311

Total, Grants to Prevent Prescription Drug/Opioid 

Overdoes-Related Deaths 12 12,000 12 12,000 12 12,000

First Responder Training (CARA)

 Grants

Continuations............................................................................. 35 19,108 59 33,218 47 27,799

New/Competing......................................................................... 20 16,892 --- --- --- ---

Subtotal.................................................................................... 55 36,000 59 33,218 47 27,799

 Contracts

Continuations............................................................................. --- --- --- --- --- ---

New/Competing......................................................................... --- --- --- 7,782 --- 13,201

Subtotal.................................................................................... --- --- --- 7,782 --- 13,201

Total First Responder Training (CARA) 55 36,000 59 41,000 47 41,000

Grants to Develop Curricula for DATA Act Waivers

 Grants

Continuations............................................................................. --- --- --- --- 117 3,500

New/Competing......................................................................... --- --- --- --- --- ---

Subtotal.................................................................................... --- --- --- --- 117 3,500

 Contracts

Continuations............................................................................. --- --- --- --- --- 230

New/Competing......................................................................... --- --- --- --- --- 270

Subtotal.................................................................................... --- --- --- --- 500

Total, Grants to Develop Curricula for DATA Act Waivers --- --- --- --- 117 4,000
254

SAMHSA/Substance Abuse Treatment

PRNS Mechanism Table by Program, Project, and Activity

(Dollars in thousands)

FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

Programs of Regional & National Significance No. Amount No. Amount No. Amount

Peer Support TA Center

 Grants

Continuations............................................................................. --- --- --- --- --- 943

New/Competing......................................................................... --- --- --- 950 --- ---

Subtotal.................................................................................... --- --- --- 950 --- 943

 Contracts

Continuations............................................................................. --- --- --- 50 --- 57

New/Competing......................................................................... --- --- --- --- --- ---

Subtotal.................................................................................... --- --- --- 50 --- 57

Total, Peer Support TA Centers --- --- --- 1,000 --- 1,000

Treatment, Recovery, and Workforce Support

 Grants

Continuations............................................................................. --- --- --- --- --- 3,770

New/Competing......................................................................... --- --- --- 3,799 --- ---

Subtotal.................................................................................... --- --- --- 3,799 --- 3,770

 Contracts

Continuations............................................................................. --- --- --- 201 --- 230

New/Competing......................................................................... --- --- --- --- --- ---

Subtotal.................................................................................... --- --- --- 201 --- 230

Total, Treatment, Recovery, and Workforce Support --- --- --- 4,000 --- 4,000

Emergency Department Alternatives to Opioids

 Grants

Continuations............................................................................. --- --- --- --- --- 4,713

New/Competing......................................................................... --- --- --- 4,749 --- ---

Subtotal.................................................................................... --- --- --- 4,749 --- 4,713

 Contracts

Continuations............................................................................. --- --- --- 251 --- 287

New/Competing......................................................................... --- --- --- --- --- ---

Subtotal.................................................................................... --- --- --- 251 --- 287

Total, Emergency Department Alternatives to Opioids --- --- --- 5,000 --- 5,000

Total, Capacity 730 444,695 873 465,842 718 350,842
255

SAMHSA/Substance Abuse Treatment

PRNS Mechanism Table by Program, Project, and Activity

(Dollars in thousands)

FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

Science and Service No. Amount No. Amount No. Amount

Addiction Technology Transfer Centers

 Grants

Continuations............................................................................. 12 8,568 12 9,026 12 9,019

New/Competing......................................................................... --- --- --- --- --- ---

Subtotal.................................................................................... 12 8,568 12 9,026 12 9,019

 Contracts

Continuations............................................................................. --- 474 --- 475 --- 537

New/Competing......................................................................... --- 4 --- -455 --- -510

Subtotal.................................................................................... --- 478 --- 20 --- 27

Total, Addiction Technology Transfer Centers 12 9,046 12 9,046 12 9,046

SAT Minority Fellowship Program

 Grants

Continuations............................................................................. 8 4,431 --- 4,042 --- 4,042

New/Competing......................................................................... --- --- --- --- --- ---

Subtotal.................................................................................... 8 4,431 --- 4,042 --- 4,042

 Contracts

Continuations............................................................................. 1 357 --- 356 --- 394

New/Competing......................................................................... --- 1 --- 390 --- 353

Subtotal.................................................................................... 1 358 --- 747 --- 747

Total, Minority Fellowship Program (MF) 9 4,789 --- 4,789 --- 4,789

Subtotal, Science and Service: 21 13,835 12 13,835 12 13,835

Total, Substance Abuse Treatment PRNS 751 458,530 885 479,677 730 364,677

* Excluding Supplements number count to avoid duplication. 
256

Grant Awards Table

(Whole Dollars)

FY 2019 Final FY 2020 Enacted FY 2021 President's Budget

Number of Awards 739 879 725

Average Award $579,184.40 $494,762.61 $425,575.47 

Range of Awards $300,000-$600,000 $300,000-$600,000 $300,000-$600,000

`
257

 State Opioid Response Grants

(Dollars in thousands)

Authorizing Legislation .............................................Section 509 of the Public Health Service Act

FY 2021 Authorization .............................................................................................$1,500,000,000

Allocation Method ....................................Competitive Grants/Contracts/Cooperative Agreements

Eligible Entities....................................Limited to Single State Agencies (SSAs) and U.S.

 Territories. Tribes and tribal organizations are eligible to apply to set-aside funds 

described below.

Program Description & Accomplishments

The State Opioid Response Grants (SOR) program was established by Congress in 2018 in order 

to address the public health crisis caused by escalating opioid misuse and addiction across the 

nation. According to the CDC, opioid related deaths numbered more than 70,000 in 2017, with 

opioids accounting for more than 47,000 of that number. The SOR program will provide resources 

to states, territories, and tribes to continue and enhance the development of comprehensive 

strategies focused upon preventing, intervening, and promoting recovery from problems related to 

opioid abuse. 

This program aims to address the opioid crisis by increasing access to medication-assisted treatment 

using the three FDA-approved medications for the treatment of opioid use disorder, reducing unmet 

treatment need, and reducing opioid overdose related deaths through the provision of prevention, 

treatment and recovery activities for opioid use disorder (OUD) (including prescription opioids, 

heroin and illicit fentanyl and fentanyl analogs. FY 2018, SAMHSA awarded grants to 57 states 

and territories via formula. The program includes a 15 percent set-aside for the 10 states with the 

highest mortality rate related to drug overdose deaths and a $50 million set-aside for tribes. 

The SOR program requires grantees to: use epidemiological data to demonstrate the critical gaps in 

availability of treatment for OUDs in geographic, demographic, and service level terms; utilize 

evidence-based implementation strategies to identify which system design models will most rapidly 

and adequately address the gaps in their systems of care; deliver evidence-based treatment 

interventions that include medication(s) FDA-approved specifically for the treatment of OUD, and 

psychosocial interventions; report progress toward increasing availability of medication-assisted 

treatment for OUD and reducing opioid-related overdose deaths.

The program supplements activities pertaining to opioids currently undertaken by the state agency 

and support a comprehensive response to the opioid epidemic. The program identifies gaps and 

resources, while building upon existing substance use prevention and treatment activities as well as 

community-based recovery support services. Grantees are required to describe how they will 

expand access to treatment and recovery support services. Grantees are required to describe how 

they will advance substance misuse prevention in coordination with other federal efforts. 

Programs of Regional & National Significance

FY 2019

 Final

FY 2020 

Enacted

 FY 2021

President's 

Budget

FY 2021 

+/-

 FY 2020

State Opioid Response Grants.................................................... $1,500,000 $1,500,000 $1,585,000 $85,000

Set-Aside for Tribes (non-add)........................................... 50,000 50,000 50,000 50,000
258

Since the SOR program began: 28,749 patients have received treatment services; 21,650 have 

received MAT (Methadone-11,727; Buprenorphine-8,982; Naltrexone-941); 26,712 patients have 

received recovery support services; 256,978 Naloxone kits have been distributed; and 13,739 

overdoses have been reversed. 

Grantees must use funding to supplement and not supplant existing opioid prevention, treatment, 

and recovery activities in their state. Grantees are required to describe how they will improve 

retention in care, using a chronic care model or other innovative model that has been shown to 

improve retention in care.

Tribal Opioid Response Grants

The Tribal Opioid Response Grants (TOR) program is supported by the $50 million set-aside for 

tribes in order to address the public health crisis caused by escalating opioid misuse and addiction 

across the nation. The program aims to address the opioid crisis in tribal communities by increasing 

access to culturally appropriate and evidence-based treatment, including medication-assisted 

treatment (MAT) using one of the three FDA-approved medications for the treatment of opioid use 

disorder (OUD). The intent is to reduce unmet treatment need and opioid overdose related deaths 

through the provision of prevention, treatment and/or recovery activities for OUD. According to 

the Centers for Disease Control and Prevention, American Indians and Alaska Natives (AI/AN) 

have had the highest drug overdose death rates in 2015 and the largest percentage increase in the 

number of deaths over time from 1999-2015 among all racial and ethnic groups. During that time, 

deaths rose more than 500 percent. 

American Indian/Alaska Native communities experience high rates of physical, emotional, and 

historical trauma and significant socioeconomic disparities, which may contribute to higher rates 

of drug abuse in the tribal communities94, The TOR program will address the gaps in prevention, 

treatment, and recovery identified by the tribes and develop strategies to purchase and disseminate 

naloxone and provide training on its use to first responders and other tribal members. 

In FY 2018, SAMHSA awarded 134 new TOR grants, representing all 10 HHS regions. 

In FY 2019, SAMHSA funded 57 SOR continuation grants, 77 TOR continuation grants, and 30 

new TOR grants. 

In FY 2020, SAMHSA anticipates funding 59 new SOR grants, and 272 new TOR grants.

 

 94 Whitesell NR, Beals J, Crow CB, Mitchell CM, Novins DK. Epidemiology and etiology of substance use among 

American Indians and Alaska Natives: risk, protection, and implications for prevention. Am J Drug Alcohol Abuse 

2012;38:376–82.
259

Funding History

Fiscal Year Amount

FY 2017 ---

FY 2018 $1,000,000,000

FY 2019 $1,500,000,000

FY 2020 $1,500,000,000

FY 2021 $1,585,000,000

Budget Request

The FY 2021 President’s Budget is $1.6 billion, an $85.0 million increase from the FY 2020 

Enacted level. The program will continue to support States and territories, including a 15 percent 

set-aside for the 10 states with the highest mortality rates related to drug overdose deaths. The 

allowable uses of this program will also be expanded to include state efforts to address stimulants, 

including methamphetamine, and cocaine. Stimulants are an increasing source of concern and are 

responsible for more deaths than opioids in a growing number of states, even as opioid overdose 

deaths remain within 5 percent of their historic high last year. 
260

Outputs and Outcomes Table

Program: State Opioid Response Grants

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

1.2.70 Number of admissions for OUD 

treatment (Output)

FY 2018: Result Expected 

December 31, 2019

Target: 56,000.0

(Pending)

Maintain 

Baseline

Maintain 

Baseline

Maintain

1.2.71 number of clients receiving 

recovery services (Output)

FY 2018: Result Expected 

December 31, 2019

Target: 52,000.0

(Pending)

Maintain 

Baseline

Maintain 

Baseline

Maintain

1.2.73 Illicit drug us at 6 months 

follow-up (Output)

FY 2018: Result Expected 

December 31, 2019

Target: 65.0

(Pending)

Maintain 

Baseline

Maintain 

Baseline

Maintain
261

Substance Abuse Prevention and Treatment Block Grant

(Dollars in thousands) 

Program

FY 2019

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

FY 2021 

+/-

FY 2020

Substance Abuse Prevention and Treatment Block Grant... $1,858,079 $1,858,079 $1,858,079 $---

 Budget Authority (non-add)............................................. 1,778,879 1,778,879 1,778,879 ---

PHS Evaluation Funds (non-add)................................ 79,200 79,200 79,200 ---

Authorizing Legislation ..........................................Section 1935 of the Public Health Service Act

FY 2021 Authorization............................................................................................. $1,858,079,000

Allocation Method....................................................................................................Formula Grants

Eligible Entities....................... States, Territories, Freely Associated States, District of Columbia, 

and the Red Lake Band of Chippewa Indians of Minnesota

Program Description and Accomplishments

The Substance Abuse Prevention and Treatment Block Grant (SABG) program distributes funds to 

60 eligible states, territories and freely associated states95, the District of Columbia, and the Red 

Lake Band of Chippewa Indians of Minnesota (referred to collectively as states) to plan, carry out, 

and evaluate substance abuse prevention and treatment, and recovery support services for 

individuals, families, and communities impacted by substance abuse and misuse. The SABG’s 

overall goal is to support and expand substance abuse prevention and treatment services while 

providing maximum flexibility to grantees.

The SABG is critically important because it provides the states and their respective SABG subrecipients, including, but not limited to, administrative service organizations, county and municipal 

governments, and prevention and treatment providers, the flexibility to respond to local and/or 

regional emergent issues impacting health, public health, and public safety through a consistent 

federal funding stream. SABG accounts for approximately 25 percent of total state substance abuse 

agency funding and 62 percent of total state substance abuse prevention and public health funding.96 

Individuals and families without health coverage or whose health insurance benefit will not cover 

certain services (e.g., recovery support) rely on services funded by the SABG. Block grant funds 

are being leveraged by states, along with other funding sources, to support training for staff and 

implementation of evidence-based practices for the prevention of substance misuse and the 

treatment of drug/alcohol addiction, improved business practices such as facilitating enrollment in 

appropriate health coverage and use of health information technology and integration of physical 

and behavioral health.97 SAMHSA encourages states to use block grant resources to support and 

not supplant services that are covered through commercial and public insurer plans.

 95 Territories include Guam, Puerto Rico, the Northern Mariana Islands, U.S. Virgin Islands and American Samoa. 

Freely Associated States, which have signed Compacts of Free Association with the United States, include the 

Republic of Palau, Federated States of Micronesia and Republic of the Marshall Islands. Retrieved from 

http://www.doi.gov//oia/islands/index.cfm

96 SABG State Agency Reported Expenditures by Target Activity Within Source of Funds, State/Jurisdiction Selection: 

All States/Jurisdictions (2015)

97 Case Studies of Three Policy Areas and Early State Innovators: 2014 State Profiles of Mental Health and 

Substance Use Disorder Agencies. HHS Publication in Press. Rockville, MD: Substance Abuse and Mental Health 

Services Administration. (2015). 
262

SAMHSA block grant funds are directed toward four purposes: 

• Fund priority treatment and support services for individuals without insurance or for whom 

coverage is terminated for short periods of time; 

• 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; 

• Fund primary prevention for individuals not identified as needing treatment (which may 

include universal programs that are targeted to the general public or a whole population 

group that has not been identified on the basis of individual risk, selective activities that are 

targeted to individuals or a subgroup of the population whose risk of developing a disorder 

is significantly higher than average, and indicated prevention activities that are targeted to 

individuals in high-risk environments, identified as having minimal but detectable signs or 

symptoms foreshadowing disorder or having biological markers indicating predisposition 

for disorder but not yet meeting diagnostic levels); and 

• Collect performance and outcome data to determine the ongoing effectiveness of behavioral 

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

services on a nationwide basis. 

SAMHSA also encourages the states to use their block grants to: 

(1) Allow the pursuit of recovery through personal choice and many pathways; 

(2) Encourage providers to assess performance based on outcomes that demonstrate client 

successes; and 

(3) Expand capacity by increasing the number and types of providers who deliver clinical treatment 

and/or recovery support services. 

Funding Allocations and Requirements

The authorizing legislation and implementing regulation governing the SABG includes a number 

of prescriptive performance and expenditure requirements as well as explicit expenditure 

prohibitions. The states and jurisdictions have the flexibility to plan, carry out, and evaluate 

substance abuse treatment and recovery support services that reflect comments received from 

individuals, families and communities during the development of their respective biennial plans 

and the results of such plans are reflected in their respective annual reports. The legislation and 

regulation prioritizes two populations to be served with SABG funds: (1) substance using pregnant 

women and women with dependent children; and (2) persons who inject drugs. Although the 

legislation and regulation prioritizes such individuals, the states and jurisdictions have the 

flexibility to prioritize other underserved populations as determined by anecdotal and empirical 

data. For example, most states and jurisdictions prioritize substance abuse treatment and recovery 

support services for adolescents and transitional age youth. Some states and jurisdictions are also 

developing peer-to-peer recovery support services to facilitate individuals’ entry to substance abuse 

treatment services and to promote and support individuals in early recovery. States and jurisdictions 

frequently partner with other executive branch departments, e.g., education, human services, justice 

and public health, to coordinate services for individuals and families impacted by substance abuse 

and misuse.
263

Formula: SABG funds are distributed98 through a formula grant that provides funding based on 

specified economic and demographic factors and is administered by SAMHSA’s Centers for 

Substance Abuse Treatment (CSAT) and Center for Substance Abuse Prevention (CSAP). Of the 

amounts appropriated for the SABG program, 95 percent are distributed to states through a formula 

included in the authorizing legislation. Factors used to calculate the allotments include total 

personal income, resident population, total population data for territories, total taxable resources, 

and a cost of services index factor. The SABG also includes “hold harmless” provisions that limit 

fluctuations in allotments as the total block grant appropriation changes from year to year. 

Maintenance of Effort: The SABG requires states to maintain its expenditures for certain substance 

abuse prevention and treatment activities at a level that is no less than the state’s average 

expenditures for the previous two years.

Funding Set-Asides and Other Requirements: The authorizing legislation and implementation 

regulation for the SABG includes specific funding set-asides, including 20 percent for primary 

prevention (see below), and five percent for early intervention service for HIV for designated 

states.99 The statute also includes performance requirements for the treatment of substance-using 

pregnant women and women with dependent children, and provides states with the flexibility to 

expend a combination of federal and non-federal funds. There are also requirements and potential 

penalty reduction of the block grant allotment if the state fails to enact and enforce laws prohibiting

the sale or distribution of tobacco products to individuals under the age of 18. 

Coordination of Efforts: SAMHSA emphasizes that block grant recipients should coordinate and 

partner with government agencies, nonprofit organizations, consumers and families and providers 

to support integrated and coordinated services and programs. SAMHSA provides targeted technical 

assistance for SABG grantees through a technical assistance contract. 

Performance and Evaluation

SAMHSA is undertaking a series of agency-wide efforts designed to develop a set of common 

performance, quality, and cost measures to demonstrate the impact of SAMHSA’s programs. 

Ultimately, SAMHSA and its state partners will collaborate to develop a streamlined behavioral 

health data system that complements other existing systems (e.g., Medicaid administrative and 

billing data systems, state mental health and substance abuse treatment data systems), ensures 

consistency in the use of measures, and provides a more complete perspective of the delivery of 

mental and substance abuse treatment services.

An independent evaluation of the SABG demonstrated how states leveraged the statutory 

requirements to expand existing or establish new treatment capacity in underserved areas of states 

and territories and to improve coordination of services with other state systems.100 SAMHSA data 

show that on average, the SABG has been successful in expanding treatment capacity by annually 

 98 Block Grants and Formula Grants: A Guide for Allocation Calculations; 2007 Department of Health and Human 

Services, SAMHSA.

99 Substance Abuse and Mental Health Services Administration. (2015). Block Grant Laws and Regulations. Retrieved 

from http://www.samhsa.gov/grants/block-grants/laws-regulations. 100 Substance Abuse and Mental health Administration. Retrieved from 

https://www.samhsa.gov/sites/default/files/grants/sapt-bg-evaluation-final-report.pdf.
264

supporting approximately two million101 admissions to treatment programs receiving public 

funding. Outcome data for the Block Grant program show positive results as reported through 

Behavioral Health Services Information System/Treatment Episode Data Set (TEDS) administered 

by SAMHSA’s Center for Behavioral Health Statistics and Quality. In FY 2019, at discharge, 

clients demonstrated above average abstinence rates from both illegal drug (56 percent) and alcohol 

(77 percent) use. State substance abuse authorities reported the following outcomes for services 

provided during FY 2019, the most recent year for which data is available:

State substance abuse authorities reported the following outcomes for services102 provided during 

FY 2019, the most recent year for which data is available:

• For the 50 states, American Samoa, the District of Columbia, Guam, Micronesia, Northern 

Marianas, and Puerto Rico that reported data concerning abstinence from alcohol use, 47 of 

the 58 identified improvements in client abstinence;

• Similarly, for the 55 states, American Samoa, the District of Columbia, Guam, Northern 

Marianas, and Puerto Rico that reported data concerning the abstinence from drug use, 40

of 58 identified improvements in client abstinence;

• For the 49 states, American Samoa, the District of Columbia, Guam, Marshall Islands, 

Micronesia, Northern Marianas, the District of Columbia, Palau, Puerto Rico, and Red 

Lake that reported employments data, 51 of 58 identified improvements in client 

employment;

• For the 49 states, American Samoa, the District of Columbia, Guam, Micronesia, Northern 

Marianas, Palau, Puerto Rico, and Red Lake that reported criminal justice data, 51 of 57 

reported an increase in clients with no arrests based on data reported to TEDS; 

• For the 49 states, American Samoa, the District of Columbia, Guam, Northern Marianas, 

Palau, and Red Lake that reported housing data, 47 of 58 identified improvements in stable 

housing for clients based on data reported to TEDS; and 

• For the 44 states, the District of Columbia, Guam, Puerto Rico, and Red Lake that reported 

recovery support data, 45 states out of 48 identified improvements in client engagement in 

recovery support programs. 

In FY 2018, states expended $707,919,493 for primary prevention activities, $1,502,538 for 

tuberculosis services, $43,367,525 for early intervention services for HIV, and $294,095,698 for 

state-level administration. All states admitted 216,690 persons to detoxification services; 273,683 

persons to rehabilitation/residential services; 958,104 persons to ambulatory services; and 206,272 

persons to opioid replacement therapy.103

 101 Source: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services 

Administration, Treatment Episode Data Set (TEDS). Data received through 01 May 2018. 102 Services include services from Short-term residential, Long-term residential, Outpatient, and Intensive outpatient 

only.

103 SABG Treatment Utilization Matrix Admissions & Persons Served by Level of Care State/Jurisdiction Selection: All 

States/Jurisdictions (2018).
265

In FY 2019, SABG funds were used to serve104 61.9 percent males and 38.1 percent females; 67.5 

percent whites; 18.4 percent blacks or African Americans; 2.3 percent American Indian/Alaska 

Natives; 0.6 percent Asians; 0.5 percent Native Hawaiian/Other Pacific Islanders; 8 percent 

Unknowns; and 2.7 percent Multiples; 85.1 percent Not Hispanic or Latino persons and 14.9 percent 

Hispanic or Latino persons; 55.4 percent persons between 25 and 44 years of age; 24.1 percent 

persons between 45 and 64 years of age; 12.9 percent persons between 18 and 24 years of age; 6.2 

percent persons between 17 years of age and under; and 1.3 percent persons between 65 years of 

age and over; and 46,814 pregnant women from all racial and ethnic groups. 

20 Percent Primary Prevention Set-Aside

SAMHSA is responsible for managing the 20 percent primary prevention set-aside of the SABG. 

The 20 percent set-aside requires SABG grantees to spend at least 20 percent of their SABG 

expenditures to develop and implement a comprehensive substance misuse prevention program, 

which includes a broad array of prevention strategies directed at individuals not identified to be in 

need of treatment.105 The prevention set-aside is one of SAMHSA’s main vehicles for supporting 

SAMHSA’s initiatives aimed at preventing substance misuse and mental illness. The 20 percent 

set-aside is focused only on substance misuse prevention. States use these funds to develop 

infrastructure and capacity and to fund programs specific to primary substance misuse 

prevention. Some states rely solely on the 20 percent set-aside to fund their prevention systems 

while others use the funds to target gaps and enhance existing program efforts. 

States are encouraged to make prevention a top priority, taking advantage of recent science, best 

practices in community coordination, proven planning processes, and the findings articulated by 

the Institute of Medicine report, Preventing Mental, Emotional, and Behavioral Disorders Among 

Young People.106 SAMHSA regularly works with states to improve their accountability systems for 

prevention and to establish necessary reporting capacities.

Synar

The Synar program is the set of actions put in place by states, with the support of the federal 

government, to implement the requirements of the Synar Amendment. The Synar Amendment 

requires states to ensure tobacco is not sold to individuals under age 18.107 The Amendment was 

developed in the context of a growing body of evidence about the health problems related to tobacco 

use by youth, as well as evidence about the ease with which youth could purchase tobacco products 

through retail sources. The Synar program is a critical component of the success of youth tobacco 

use prevention efforts. SAMHSA is charged with overseeing states’ implementation of the Synar 

requirements and provides consultation to states to ensure compliance with the Synar requirements.

While the national weighted retailer violation rate declined steadily from 40.1 percent in the 

program’s baseline year in FY 1997 through FY 2011, the rate increased from an all-time low of 

8.5 percent in FY 2011 to 11 percent in FY 2015. Although the rate has declined in each year since 

 104 SABG Unduplicated Persons Served – Graphical Presentation All States/Jurisdictions (2019). 105 Substance Abuse and Mental Health Services Administration (2015). Substance Abuse Prevention and Treatment 

Block Grant. Retrieved from http://www.samhsa.gov/grants/block-grants/sabg 106 "Front Matter." Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and 

Possibilities. Washington, DC: The National Academies Press, 2009. Retrieved from 

https://www.ncbi.nlm.nih.gov/books/NBK32775/.

107 Substance Abuse and Mental Health Services Administration (2015). Synar Program. Retrieved from 

http://www.samhsa.gov/synar 
266

FY 2015, it has not returned to the historic low of FY 2011. One of the greatest predictors of a 

state's retailer violation rate is the amount and reach of their enforcement efforts. As states have 

faced budget shortfalls, some have scaled back their enforcement programs and this may be 

contributing to the higher rates of tobacco sales to youth. Also, under the Synar program, SAMHSA 

encourages states to include in their inspections the types of tobacco products most often used by 

youth in their states. As states have expanded the types of tobacco products included in their Synar 

inspections, some states are reporting that retailers are sometimes more likely to sell non-cigarette 

tobacco products, including smokeless tobacco, to youth. These factors are likely contributing to 

the overall increase in the national weighted retailer violation rate since FY 2011. SAMHSA is 

addressing this increase by providing consultation to states, as well as examining Synar data in 

order to provide states with guidance on best practices including enforcement, merchant education, 

and community mobilization. 

Technical Assistance

In addition to the states’ and jurisdictions’ plans and reports, the authorizing legislation provides 

SAMHSA with significant resources to support targeted technical assistance to the SABG grantees 

and their respective sub-recipients, i.e., community- and faith-based organizations approved by the 

states and jurisdictions to provide substance abuse treatment and recovery support services. 

SAMHSA’s Knowledge Application Program (KAP) (http://www.samhsa.gov/kap) produces the 

Technical Assistance Publication Series that provide practical guidance and information related to 

the delivery of substance abuse treatment services and related public health services to individuals 

and families. The KAP also produces the Treatment Improvement Protocol Series, a growing 

library of best practice guidelines, which are produced by a consensus-development process based 

on the experience and knowledge of clinical, research, and administrative experts.

Program Evaluation

The SABG provides for the planning and development of a comprehensive statewide system of care 

and services that emphasizes the importance of the provision of a broad continuum of services and 

supports encompassing prevention, treatment, and recovery across the population age range. 

Among the critical populations identified as priorities for outreach and intervention are pregnant 

and postpartum women, persons who inject drugs, persons at risk for HIV, justice-involved 

populations, people with co-occurring mental disorders, and persons experiencing homeless. 

The SABG is beneficial to states in that the program:

• Aids in having a positive effect on the health and lives of individuals with substance use 

disorders as evidenced by demonstrated positive client outcomes in all six treatment 

domains; 

• Acts as a major impetus for improving State prevention and treatment systems’ 

infrastructure and capacity thereby increasing availability of services, development and 

implementation of evidence-based practices, development and collection of specific 

outcome measures, and development and maintenance of State data management systems; 

• Requirements, resources, and Federal guidance can be leveraged to sustain and improve 

State systems and emphasize the importance of the SABG in the development of the same; 

and 
267

• Contributes to the development and maintenance of successful State collaborations with 

other agencies and stakeholders concerned with preventing and treating substance use 

disorders.

Funding History

 Fiscal Year Amount

 FY 2011 $1,782,528,000

 FY 2012 $1,800,332,000

 FY 2013 $1,710,306,376

 FY 2014 $1,815,443,000

 FY 2015 $1,819,856,000

 FY 2016 $1,858,079,000

 FY 2017 $1,857,079,000

 FY 2018 $1,858,079,000

 FY 2019 $1,858,079,000

 FY 2020 $1,858,079,000

 FY 2021 $1,858,079,000

 

Budget Request

The FY 2021 President’s Budget is $1.9 billion, level with the FY 2020 Enacted level. SABG funds 

will continue to serve as a source of safety net funding, including assistance to states in addressing 

the opioid epidemic, and will continue to support certain services (e.g., recovery support services) 

not covered by commercial insurance and non-clinical activities and services that address the 

critical needs of state substance abuse prevention and treatment service systems.
268

Substance Abuse and Mental Health Services Administration

FY 2021 Substance Abuse Prevention and Treatment Block Grant Final Allotment

Appropriation Amount $1,858,079,000, State-Territory Total $1,760,215,857

State/Territory

FY 2019

Final

FY 2020

Enacted

FY 2021

President's 

Budget

FY 2021

+/-

FY 2020

Alabama $23,093,030 $23,090,733 $23,086,979 -$3,754

Alaska 5,889,978 5,889,392 5,888,435 -957

Arizona 40,432,857 40,428,835 40,468,207 39,372

Arkansas 13,526,573 13,525,228 13,523,028 -2,200

California 254,453,810 254,428,502 254,387,137 -41,365

Colorado 28,919,201 28,916,325 28,911,624 -4,701

Connecticut 18,215,021 18,213,209 18,210,248 -2,961

Delaware 6,968,866 6,968,173 6,967,040 -1,133

District Of Columbia 6,968,866 6,968,173 6,967,040 -1,133

Florida 111,396,395 111,385,315 111,367,206 -18,109

Georgia 57,160,990 57,155,304 57,146,012 -9,292

Hawaii 8,583,536 8,582,682 8,581,287 -1,395

Idaho 8,537,148 8,536,299 8,534,911 -1,388

Illinois 67,656,161 67,649,432 67,638,433 -10,999

Indiana 32,251,036 32,247,828 32,242,586 -5,242

Iowa 13,095,358 13,094,055 13,091,926 -2,129

Kansas 11,901,489 11,900,305 11,898,370 -1,935

Kentucky 20,381,502 20,379,475 20,376,162 -3,313

Louisiana 25,030,273 25,027,783 25,023,714 -4,069

Maine 6,968,866 6,968,173 6,967,040 -1,133

Maryland 34,085,216 34,081,826 34,076,285 -5,541

Massachusetts 39,851,201 39,847,237 39,840,759 -6,478

Michigan 56,061,458 56,055,882 56,046,768 -9,114

Minnesota 24,105,738 24,103,340 24,099,421 -3,919

Mississippi 13,805,681 13,804,308 13,802,064 -2,244

Missouri 26,552,550 26,549,909 26,545,593 -4,316

Montana 6,968,866 6,968,173 6,967,040 -1,133

Nebraska 7,642,413 7,641,653 7,640,410 -1,243

Nevada 17,006,003 17,004,311 17,001,547 -2,764
269

Substance Abuse and Mental Health Services Administration

FY 2021 Substance Abuse Prevention and Treatment Block Grant Final Allotment

Appropriation Amount $1,858,079,000, State-Territory Total $1,760,215,857

State/Territory

FY 2019

Final

FY 2020

Enacted

FY 2021

President's 

Budget

FY 2021

+/-

FY 2020

New Hampshire 6,968,866 6,968,173 6,967,040 -1,133

New Jersey 48,071,571 48,066,790 48,058,975 -7,815

New Mexico 9,566,582 9,565,630 9,564,075 -1,555

New York 111,847,228 111,836,103 111,817,922 -18,181

North Carolina 44,998,815 44,994,339 44,987,024 -7,315

North Dakota 6,534,551 6,533,901 6,532,839 -1,062

Ohio 64,545,643 64,539,223 64,528,731 -10,492

Oklahoma 17,151,973 17,150,267 17,147,479 -2,788

Oregon 20,581,505 20,579,458 20,576,112 -3,346

Pennsylvania 59,109,273 59,103,394 59,093,785 -9,609

Rhode Island 7,599,642 7,598,886 7,597,651 -1,235

South Carolina 23,721,414 23,719,055 23,715,199 -3,856

South Dakota 6,042,638 6,042,037 6,041,055 -982

Tennessee 31,983,156 31,979,975 31,974,775 -5,200

Texas 144,730,887 144,716,491 144,692,964 -23,527

Utah 16,591,127 16,589,477 16,586,779 -2,698

Vermont 6,460,866 6,460,223 6,459,173 -1,050

Virginia 41,986,348 41,982,172 41,975,347 -6,825

Washington 37,790,464 37,786,705 37,780,561 -6,144

West Virginia 8,433,974 8,433,135 8,431,764 -1,371

Wisconsin 27,202,159 27,199,453 27,195,032 -4,421

Wyoming 4,198,203 4,197,785 4,197,103 -682

Red Lake Indians 594,118 594,059 593,962 -97

American Samoa 345,273 346,037 346,491 454

Guam 1,104,675 1,124,417 1,143,734 19,317

Northern Marianas 347,649 351,136 354,453 3,317

Puerto Rico 22,580,187 22,519,704 22,460,092 -59,612

Palau 141,293 143,987 146,679 2,692

Marshall Islands 485,666 500,800 515,952 15,152

Micronesia 693,121 700,055 706,554 6,499

Virgin Islands 711,594 720,695 729,283 8,588
270

Outputs and Outcomes Table

Program: Prevention Set-Aside

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

2.3.63 Increase the percent of states 

showing an increase in state level 

estimates of survey respondents who rate 

the risk of substance abuse as moderate 

or great (age 12-17) (Outcome)

FY 2017: 37.3 %

Target: 37.3 %

(Baseline)

37.3 % 37.3 % Maintain

2.3.65 Increase the percent of states 

showing a decrease in state level 

estimates of percent of survey 

respondents who report 30 day use of 

alcohol (age 12-20) (Outcome)

FY 2017: 53 %

Target: 67.5 %

(Target Not Met)

67.5 % 67.5 % Maintain

2.3.67 Increase the percent of states 

showing a decrease in state level 

estimates of percent of survey 

respondents who report 30 day use of 

other illicit drugs (age 12-17) (Outcome)

FY 2017: 51 %

Target: 51 %

(Baseline)

63 % 63 % Maintain

2.3.68 Increase the percent of states 

showing a decrease in state level 

estimates of percent of survey 

respondents who report 30 day use of 

other illicit drugs (age 18+) (Outcome)

FY 2017: 20 %

Target: 20 %

(Baseline)

43 % 43 % Maintain
271

Outputs and Outcomes Tables

Program: Treatment Activities

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

1.2.43 Increase the number of admissions 

to substance abuse treatment programs 

receiving public funding (Output)

FY 2015: 1,806,941

Target: 1,937,960

(Target Not Met)

1,880,000 1,880,000 Maintain

1.2.48 Percentage of clients reporting no 

drug use in the past month at discharge 

(Outcome)

FY 2016: 69.6 %

Target: 74 %

(Target Not Met)

74 % 74 % Maintain

1.2.49 Increase the percentage of clients 

reporting no alcohol use in the past 

month at discharge (Outcome)

FY 2016: 83.1 %

Target: 78 %

(Target Exceeded)

78 % 78 % Maintain

1.2.50 Increase the percentage of clients 

reporting being employed/in school at 

discharge (Outcome)

FY 2016: 35.7 %

Target: 43 %

(Target Not Met)

40 % 40 % Maintain

1.2.51 Increase the percentage of clients 

reporting no involvement with the 

Criminal Justice System (Outcome)

FY 2016: 93.2 %

Target: 92 %

(Target Exceeded)

92 % 92 % Maintain

1.2.85 Increase the percentage of clients 

receiving services who had a permanent 

place to live in the community 

(Outcome)

FY 2016: 88.9 %

Target: 92 %

(Target Not Met)

92 % 92 % Maintain
272

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273

SAMHSA 

Health Surveillance and Program Support

Table of Contents

1. Health Surveillance ........................................................................................................ 273

2. Drug Abuse Warning Network ...................................................................................... 281

3. Performance and Quality Information Systems.............................................................. 284

4. Program Support ............................................................................................................. 289

5. Public Awareness Support .............................................................................................. 291
274

Health Surveillance

(Dollars in thousands) 

Program Activity

FY 2019

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

FY 2021 

President's 

Budget 

+/-

FY 2020 

Enacted

Health Surveillance.............................................. $47,258 $47,258 $33,842 -$13,416

Budget Authority (non-add)............................ 16,830 16,830 2,389 -14,441

PHS Evaluation Funds (non-add)................. 30,428 30,428 31,453 1,025

Data Request and Publication User Fees............. $1,500 $1,500 $1,500 $---

Authorizing Legislation ............................. Sections 501 and 505 of the Public Health Service Act

FY 2021 Authorization .................................................................................................... Permanent

Allocation Method .................................................................. Federal/Intramural, Contracts, Other

Eligible Entities.........................................................................................................Not Applicable

Program Description and Accomplishments

The Health Surveillance funding primarily supports the activities of the Center for Behavioral 

Health Statistics and Quality (CBHSQ). The detailed funding for each activity along with a detailed 

narrative description of each project follows.
275

Resources by Activity/Program

(Dollars in thousands)

FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

FY 2021 

President's 

Budget

+/-

FY 2020 

Enacted

Health Surveillance and Program Support Appropriation

Health Surveillance

Population Data Collection, Analysis, and Dissemination $15,024 $17,938 $13,246 -$4,693

National Survey on Drug Use and Health (NSDUH)................ 9,491 14,595 11,196 -3,399

Treatment Services Data Collection, Analysis, and 

Dissemination 13,710 23,103 14,302 -8,801

Behavioral Health Services Information System (BHSIS)....... 13,710 23,103 14,302 -8,801

Behavioral Health Data Dissemination 324 619 693 74

Substance Abuse and Mental Health Data Archive (SAMHDA).... 324 619 693 74

Performance Measurement/Systems 462 299 1,065 766

SAMHSA Performance Accountability Reports System (SPARS)... --- --- 752 752

WebBGAS.................................................................................... 296 299 313 13

Program Evaluations 750 750 --- -750

TTC Evaluation............................................................................ 750 750 --- -750

Evidence-Based Programs/Practices 215 --- --- ---

Evidence Based Resource Center................................................ --- --- --- ---

Drug Abuse Warning Network............................................... --- 2,845 3,061 217

PHS Evaluation (non add).................................................. --- --- 3,061 3,061

Innovation and Logistical Services Support 10,947 --- --- ---

PHS Evaluation (non add)................................................. 3,404 --- --- ---

Support 5,826 1,704 1,476 -228

Operations.................................................................................. 1,926 1,704 1,476 -228

Payroll........................................................................................ 3,900 --- --- ---

Total Health Surveillance $47,258 $47,258 $33,842 -$13,416

Overview

The Center for Behavioral Health Statistics and Quality is the government’s lead agency for 

behavioral health statistics. Authorized by Section 505 of the Public Health Service Act, which 

was reauthorized and amended by Section 6004 of the 21st Century Cures Act, CBHSQ performs 

activities that: (1) coordinate SAMHSA’s integrated data strategy, including collecting data each 

year; (2) provide statistical and analytical support for SAMHSA’s activities; (3) manage a core set 

of performance metrics to evaluate activities supported by SAMHSA; (4) coordinate with the 

Assistant Secretary, the Assistant Secretary for Planning and Evaluation, National Mental Health 

and Substance Use Policy Lab, and SAMHSA’s Chief Medical Officer, as appropriate, to improve 

the quality of data collection services and evaluations of SAMHSA activities. 

CBHSQ activities are integrated and cross over multiple funding lines. CBHSQ receives funding 

for Health Surveillance (HS), Drug Abuse Warning Network (DAWN), and Performance and 

Quality Information Systems (PQIS) within the Health Surveillance and Program Support 

appropriation (HSPS) funding sources and the Substance Abuse Treatment appropriation from 

Block Grant Set Aside (BGSA) funding sources. Programs are often funded from several sources. 

(A table detailing All Funding Sources follows the PQIS section). Under Health Surveillance, 

CBHSQ work includes Population Data Collection, Analysis, and Dissemination; Treatment 
276

Services Data Collection, Analysis, and Dissemination; and Behavioral Health Data Dissemination. 

Under PQIS, CBHSQ activities include Performance Measurement/Systems, Behavioral Health 

Data Dissemination, and Evidence-Based Programs/Practices.

The FY 2021 Request is $110.4 million which is $13.4 million lower than the FY 2020 Enacted, 

this includes $54.8 million from Health Surveillance and Program Support (HSPS) Appropriation 

and $55.6 million from the Substance Abuse Treatment (SAT) Appropriation.

Population Data Collection, Analysis, and Dissemination

Section 505 of the Public Health Service Act (42 USC 290aa-4) requires SAMHSA to annually 

collect prevalence data on substance use and mental illness. To accomplish this, SAMHSA 

administers the National Survey on Drug Use and Health (NSDUH). NSDUH is an annual 

collection of behavioral health data on approximately 67,500 persons aged 12 or older of the U.S. 

civilian, non-institutionalized population. NSDUH is the nation’s primary source of statistical 

information on the use of illicit drugs, alcohol, and tobacco, certain mental health issues, cooccurring drug/alcohol addiction and mental illness, and treatment for substance abuse and mental 

health issues. NSDUH data provide estimates at the national, state, and sub-state level and among 

demographic, socioeconomic or geographic subgroups, as well as trend estimates over time. 

NSDUH data provide states the opportunity to focus on their leading public health challenges 

through the release of state-specific data. Each year, three simultaneous NSDUH activities are 

ongoing: planning for future surveys, collecting data on over 67,500 persons in the current year 

survey, and analysis and dissemination of data from previous collections. In 2018, SAMHSA began 

a NSDUH redesign to ensure the survey is clinically up-to-date through alignment of questions with 

the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Other potential 

areas for the next possible redesign include, but are not limited to, electronic cigarettes and vaping, 

synthetic cannabinoids, and revising the substance abuse and mental health treatment measures to 

produce national estimates.

Based on the 2018 NSDUH survey data an estimated 31.9 million Americans aged 12 or older, or 

11.7 percent were current (past month) illicit drug users.108 In addition, an estimated 19.1 percent 

of adults ages 18 and older had any mental illness in the past year (47.6 million) and 4.6 percent 

(11.4 million) of adults had serious mental illness. 

 

SAMHSA included medication-assisted treatment and Kratom questions for the 2019 Survey, and 

will include vaping, synthetic cannabinoids and stimulant use, and craving and withdrawal 

questions based on DSM-5 for the 2020 survey. 

NSDUH data are disseminated through public-use files made available online on the Substance 

Abuse and Mental Health Data Archive (SAMHDA) and restricted use data files that are available 

at the National Center for Health Statistics (NCHS) Research Data Centers (RDCs) through an 

application process. Collectively, in FY 2018 and FY 2019, approximately 200 reports and articles 

 124Substance Abuse and Mental Health Services Administration. (2018). Key substance use and mental health 

indicators in the United States: Results from the 2017 National Survey on Drug Use and Health (HHS Publication No. 

PEP19-5068, NSDUH Series H-54). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance 

Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/
277

were written by external researchers using SAMHDA data. In FY 2019, over 100,000 NSDUH 

download events for SAMHDA occurred and around 200,000 page views on the NSDUH 

webpages; in FY 202020, the same volume is anticipated. CBHSQ staff also responded to almost 

700 requests for NSDUH data in FY 2019, including those from other Federal agencies, state and 

local governments, the media, researchers, and the public.

Treatment Services Data Collection, Analysis, and Dissemination

Section 505 of the Public Health Service Act (42.U.S.C. 290aa-4) requires SAMHSA to collect 

data on mental illness and substance abuse treatment services. For this purpose, CBHSQ developed 

the Behavioral Health Services Information System (BHSIS). Data collected through the BHSIS 

provides information to the public on treatment services through the Behavioral Health Treatment 

Services Locator, part of the National Treatment Referral Service. The Locator provides accurate, 

timely, and regularly updated information on mental health and substance abuse treatment facilities 

across the country. BHSIS includes multiple data collection programs and information resources. 

BHSIS data collections comprise: (1) the National Mental Health Services Survey (N-MHSS) 

which provides information on all public and private specialty mental health disorder treatment 

facilities in the United States; in 2018, the overall response rate was 90 percent; (2) the National 

Survey of Substance Abuse Treatment Services (N-SSATS) which provides information on all 

public and private substance abuse treatment facilities in the United States; in 2018, the overall 

response rate was 90 percent; (3) the Treatment Episode Data Set (TEDS) which provides 

demographic and services information on publicly funded admissions and discharges from 

substance abuse treatment; (4) the Mental Health Treatment Episode Data Set (MH-TEDS) and the 

Mental Health Client Level Data (MH-CLD) which provide demographic and services information 

on publicly funded admissions and discharges of clients in mental health treatment; and (5) the 

Uniform Reporting System (URS) which provides a set of standardized data tables submitted 

annually by states and territories as part of their Mental Health Block Grant (annual implementation 

reports. SAMHSA is reviewing and updating N-SSATS and N-MHSS questions for the 2019 and 

2020 surveys.

Another element of the BHSIS is the Inventory of Behavioral Health Services (I-BHS) which 

provides a listing of all known mental health and substance abuse treatment facilities, including 

active, inactive, open and closed facilities. As of December 2019, I-BHS had identified 21,723 

active substance abuse treatment facilities and 14,984 active mental health treatment facilities in 

the United States and its territories.

In FY 2019 the Behavioral Treatment Locator Homepage received more than 1.3 million page

views while the actual locator map had over 900,000 page views from individuals, families, 

community groups, and organizations to identify appropriate treatment services.

In FY 2019, GSA 18F in an inter-agency agreement with SAMHSA, completed their project goal 

to create a user-centric website to help them receive the education, information and resources best 

suited to their treatment situation. The website has been built off of primary research including 

focus groups, data from the current SAMHSA treatment locator, and search trends. The project was 

launched by SAMHSA and the White House on October 30, 2019 and from that date to December 

9, 2019 the homepage has received over 90,000 page views, with over 66,000 results run by 

individuals, families, community groups, and organizations to identify appropriate substance use 

treatment services.
278

In FY 2019 the data webpage received over 2.3 million page views. Through the data webpage the 

public downloaded over 20,000 BHSIS publications; this included 4,868 downloads of TEDS 

publications and 5,717 downloads of URS tables. The public also downloaded over 90,000 NSDUH 

publications. In FY 2020, SAMHSA plans to award a new BHSIS contract for the annual N-SSATS 

and N-MHSS and TEDS, MH-CLD, URS and Locator. 

Behavioral Health Data Dissemination

Substance Abuse and Mental Health Data Archive (SAMHDA) makes public-use data files 

available to anyone for download, in a variety of formats. Once downloaded, a user can use their 

own software to manipulate and explore the data. In FY 2019 users downloaded over 216,000 

public use files from SAMHDA, accessed the data visualization tool over 5,000 times, and 

generated over 25,000 tables using web-based analytic tools. Through SAMHDA, CBHSQ 

provides access to public and restricted-use data through a web-based analytic tool. The analytic 

tool was launched in April 2017 and allows researchers to generate tables based on this data.

Historically CBHSQ has managed two separate websites/interfaces for data dissemination to the 

public. There is a data webpage, which makes reports, survey information, and supporting 

documentation available. This site currently resides at https://www.samhsa.gov/data/. There is 

also a data archive, the Substance Abuse and Mental Health Data Archive (SAMHDA), which 

makes public-use files and analytic tools available to the public. This site currently resides at 

https://datafiles.samhsa.gov/. While SAMHDA’s target population is researchers, the analytic 

tools available for access can be useful for various public audiences. SAMHSA has decided to 

remove overlapping functions and combine the SAHMDA and data webpage into a single 

contract. This migration will provide cost savings, eliminate duplicative work, allow for easier, 

more efficient access to all SAMHSA data in one place and promote the goal of expanding data 

dissemination related to behavioral health.

 

In an effort to further broaden researcher access to restricted-use micro-level data, SAMHSA 

collaborated with the National Center for Health Statistics (NCHS) to host SAMHSA restricteduse micro data at NCHS Research Data Centers (RDCs). Providing access to SAMHSA restricteduse data through the NCHS RDCs promote broader researcher access to these data and ensuring 

that researchers can access restricted-use data for important public health research.
279

Funding History

Fiscal Year Amount

FY 2017

FY 2018

 $47,258,000

 $47,258,000

FY 2019 $47,258,000

FY 2020 $47,258,000

FY 2021 $33,842,000

Budget Request

The FY 2021 President’s Budget request is $33.8 million, which is a decrease of $13.4 million from 

the FY 2020 Enacted. SAMHSA intends to continue funding the continuation of the NSDUH, 

BHSIS, SAMHDA, and EBPRC contracts.
280

Mechanism Table for Health Surveillance

(Dollars in thousands)

Program Activity

FY 2019 

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

No. Amount No. Amount No. Amount

Health Surveillance

Contracts

Continuations.............................................. 2 $47,258 2 $37,781 1 $33,090 

New/Competing.......................................... --- --- --- 9,477 --- 752 

Subtotal.................................................... 2 47,258 2 47,258 1 33,842 

Total, Health Surveillance 2 47,258 2 47,258 1 33,842 
281

Outputs and Outcomes Table

Program: National Survey on Drug Use and Health

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

2.3.19L Percentage of 

adults with Serious Mental 

Illness (SMI) receiving 

mental health services 

(Outcome)

FY 2018: Result Expected 

December 31, 2019

Target: 66.0 %

(Pending)

71.0 % 75.0 % +4 %

2.3.19M Percentage of 

people who meet criteria for 

needing substance use 

treatment who receive 

treatment from a specialty 

substance use disorder 

treatment provider 

(Outcome)

FY 2018: Result Expected 

December 31, 2019

Target: 11.5 %

(Pending)

12.5 % 14.0 % +1.5 %

2.3.19N Past year 

prescription pain reliever 

misuse (age 12 and older) 

(Outcome)

FY 2018: Result Expected 

December 31, 2019

Target: 9,500,000.0

(Pending)

9,500,000.0 9,500,000.0 Maintain

2.3.19O Percent of youth 

ages 12-17 who experienced 

major depressive episodes 

with severe impairment in 

the past year receiving 

treatment for depression. 

(Outcome)

FY 2018: Result Expected 

December 31, 2019

Target: 43.0 %

(Pending)

50.0 % 55.0 % +5 %
282

Drug Abuse Warning Network (DAWN)

(Dollars in thousands)

Program Activity

FY 2019

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

FY 2021 

President's 

Budget 

+/-

FY 2020 

Enacted

Drug Abuse Warning Network............................ $10,000 $10,000 $10,000 $---

PHS Evaluation Funds (non-add)................ --- --- 10,000 10,000

Authorizing Legislation..................................Section 505 of the Public Health Service Act

FY 2021 Authorization ..................................................................................................$10,000,000

Allocation Method ............................................................................................................. Contracts

Eligible Entities.........................................................................................................Not Applicable

Program Description and Accomplishments Est date for all 50 hospitals when they will be 

signed up. 

SAMHSA re-established DAWN as a nationwide public health surveillance system to monitor 

emergency department (ED) visits related to recent substance use, including those related to 

opioids. Authorized by the 21st Century Cures Act, this program is necessary to respond effectively 

to the opioid and addiction crisis in the United States and to better inform public health, clinicians, 

policymakers, and other stakeholders to respond to emerging substance use trends. 

By using data abstracted directly from ED records, DAWN will capture detailed information about 

the substances involved in ED visits and will serve as an early warning system for the emergence 

of new and novel psychoactive substances. DAWN is currently developing and testing an 

automated method to detect any sudden increases in visits involving specific substances in its 

hospitals. It will monitor the geographic, temporal and demographic characteristics of drug-related 

ED visits. Unlike other public health surveillance systems, DAWN will capture both ED visits that 

are directly caused by drugs, such as overdoses, and those in which drugs are a contributing factor 

but not the direct cause of the ED visit, such as motor vehicle crashes where the driver had mixed 

medications with alcohol. These criteria encompass all types of drug-related events, from substance 

use and misuse to substance-related suicide attempts, accidental ingestion and adverse reactions to 

pharmaceuticals. The detailed information captured by DAWN will be used to assess health 

hazards associated with specific substances, and monitor the impact of drug use, misuse, and abuse 

on the Nation's health care system.

There are several important improvements for the new DAWN including timeliness of data, data 

available at more frequent intervals, and data abstracted from a wider range of geographic area 

types, including urban, suburban and rural areas. Having data available more quickly means that 

DAWN can serve as a true “early warning” system and inform public health response efforts in 

local areas. DAWN is currently developing recommendations on how and with whom to share the 
283

near real-time unweighted data. A system to provide participating hospitals access to data 

visualizations for their own hospitals is in development and will be implemented during FY2020.

DAWN data are abstracted from hospital emergency department records. Hospital participation is 

optional. SAMHSA currently is at 76% in achieving targeted hospital participation and anticipates 

being at 100% by the end of FY 2020 as planned.

Funding History

Fiscal Year Amount

FY 2017

FY 2018

---

$10,000,000

FY 2019 $10,000,000

FY 2020 $10,000,000

FY 2021 $10,000,000

Budget Request

The FY 2021 President’s Budget request is $10.0 million, level with the FY 2020 Enacted. 
284

Mechanism Table for Drug Abuse Warning Network

(Dollars in thousands)

Program Activity

FY 2019 

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

No. Amount No. Amount No. Amount

Drug Abuse Warning Network

Contracts

Continuations......................................................... 1 10,000 1 10,000 1 10,000 

New/Competing.................................................... --- --- --- --- --- ---

Subtotal............................................................. 1 10,000 1 10,000 1 10,000 

Total, Drug Abuse Warning Network 1 10,000 1 10,000 1 10,000 
285

Performance and Quality Information Systems

(Dollars in thousands) 

Program Activity

FY 2019

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

FY 2021 

President's 

Budget 

+/-

FY 2020 

Enacted

Performance and Quality Information Systems........... $10,000 $10,000 $10,000 $---

Authorizing Legislation .................. Sections 501, 505, 509, 516, 520A, and 543A of the PHS Act

FY 2021 Authorization ......................................................................................................Indefinite

Allocation Method ............................................................................................................. Contracts

Eligible Entities.........................................................................................................Not Applicable

Program Description and Accomplishments 

The Performance and Quality Information Systems (PQIS) funding primarily supports the activities 

of the Center for Behavioral Health Statistics and Quality (CBHSQ). The detailed funding for each 

activity along with a detailed narrative description of each project follows.

Performance and Quality Information Systems

Resources by Activity/Program

(Dollars in thousands)

FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

FY 2021 

President's 

Budget

+/-

FY 2020 

Enacted

Performance and Quality Information Systems

Performance Measurement/Systems $6,632 $6,832 $7,056 $225

SAMHSA Performance Accountability Reports System (SPARS)... 6,632 6,832 7,056 225

Evidence-Based Programs/Practices 1,785 2,000 2,000 ---

Evidence Based Resource Center............................................... 1,785 2,000 2,000 ---

Drug Abuse Warning Network (DAWN) 1,009 483 259 -225

DAWN..................................................................................... 1,009 483 259 -225

Support 574 685 685 ---

Operations.................................................................................. 574 685 685 ---

Total Performance and Quality Information Systems $10,000 $10,000 $10,000 $---
286

Performance Measurement and Performance Systems

SAMHSA collects data on key output and outcome measures to monitor and manage grantee 

performance, improve the quality of services provided, and inform the public and stakeholders.

SAMHSA collects this data in the SAMHSA Performance Accountability and Reporting System.

Data collected through SPARS are used to monitor the progress of SAMHSA’s discretionary grants, 

serve as a decision-making tool on funding, and improve the quality of services provided through 

the programs. SAMHSA will continue to implement the 21st Century Cures Act and make any 

necessary changes to improve the performance metrics used and to evaluate effectiveness of 

SAMHSA programs including updating client level data collection tools and modernizing the 

SPARS data collections system. Modernization activities will result in capturing real-time data 

using clinical diagnostic tools to document impact and effectiveness and develop benchmarks for 

performance evaluation. 

SAMHSA will deploy new system functionality within SPARS that enhances performance 

monitoring analyses functionality, including but not limited to: (1) data validation and verification, 

data management, (2) data utilization, (3) data analysis support, (4) automated reporting, and (5) 

additional ad hoc data analysis. The SPARS project also includes technical support, staff training, 

and help desk assistance to ensure SAMHSA effectively manages its grant portfolio and to provide 

timely, accurate information to policy makers and all stakeholders.

Program Evaluation

The Office of Evaluation (OE) is responsible for providing centralized planning and management 

across SAMHSA. In partnership with program originating Centers, OE provides oversight and 

management of agency quality improvement and performance management activities and advance 

agency goals and objectives relating to, performance measurements, and quality improvement. OE 

activities include development of evaluation language for funding announcements to ensure a clear 

statement of evaluation objectives, development and implementation of standard measures for 

evaluating program performance and improvement of services. OE identifies and maintains 

performance indicators to monitor each SAMHSA program and develop periodic evaluation reports 

for use in agency planning, program change, and reporting to departmental and external 

organizations. The OE works collaboratively with the National Mental Health and Substance Use 

Policy Lab (NMHSUPL) and the Office of the Chief Medical Officer to provide support for 

SAMHSA evaluations.

Evidence-Based Practice Resource Center (EBPRC) 

Section 7002 of the 21st Century Cures Act requires SAMHSA to improve access to reliable and 

valid information on evidence-based programs and practices, including information on the strength 

of evidence associated with such programs and practices related to mental illness and drug/alcohol 

addiction. This information on evidence-based programs and practices is provided to states, local 

communities, non-profit entities, and other stakeholders, on SAMHSA’s website information.

This Resource Center, which is managed by the NMHSUPL, aims to provide communities, 

clinicians, policy-makers and others in the field with the information and tools they need to 

incorporate evidence-based practices into their communities or clinical settings. As part of this 

effort, SAMHSA develops and disseminates additional resources such as new or updated Treatment 
287

Improvement Protocols, guidance documents, clinical practice policies, toolkits, systematic 

reviews, data reports and other actionable materials that incorporate the latest scientific evidence 

on mental health and substance use and address priority areas where more information or guidance 

are needed to help the field move forward. This approach enables SAMHSA to more quickly 

develop and disseminate expert consensus on the latest prevention, treatment, and recovery science. 

The EBPRC currently lists 167 resources. SAMHSA expects to add at least 15 resources, including 

six SAMHSA developed practice guides, to coincide with the EBPRC website redesign in FY 2020.

The EBPRC enables SAMHSA to collaborate with experts in the field to rapidly translate science 

into action; and provide communities and practitioners with tools to facilitate comprehensive needs 

assessment, match interventions to those needs, support implementation, and evaluate and 

incorporate continuous quality improvement into their prevention, treatment, and recovery 

efforts. This strategy coupled with SAMHSA’s new regional and locally-based training and 

technical assistance efforts will help to ensure that communities and practitioners are equipped to 

bring about the improvements in mental health and substance use prevention, treatment, and 

recovery our Nation requires. As SAMHSA moves forward, the EBPRC website will continue to 

develop content and improve its functionality to enable a broad audience to efficiently access 

materials. 

Behavioral Health Quality Measures

Behavioral health quality activities are housed within CBHSQ. The Center provides oversight of 

the agency’s quality improvement efforts, including the identification of gaps in behavioral health 

quality measurement and the adoption and implementation of behavioral health quality measures. 

This work includes partnerships with the Center for Medicare & Medicaid Services (CMS) and the 

Assistant Secretary for Planning and Evaluation (ASPE), among other Federal partners, in quality 

measure work. CBHSQ serves as the SAMHSA lead to the National Quality Forum (NQF) as well 

as participates as a Federal advisor for other agencies conducting measure development work, 

including CMS and ASPE. CBHSQ also participates on the Measures Application Partnership, a 

group convened to guide HHS on measure adoption. 

CBHSQ staff provides internal collaborations across SAMHSA, advising on quality measure issues 

and identifying key next steps. CBHSQ staff regularly consults with other Federal agencies, the 

NQF, and other key stakeholders regarding behavioral health quality indicators, including barriers 

to and facilitators of data collection, tracking, and reporting. SAMHSA continues its behavioral 

health quality measure activities through ongoing identification of behavioral health measurement 

gaps and the capacity to address such gaps. 
288

Funding History

Fiscal Year Amount

FY 2017

FY 2018

$10,000,000

$10,000,000

FY 2019 $10,000,000

FY 2020 $10,000,000

FY 2021 $10,000,000

Budget Request

The FY 2021 President’s Budget request of $10.0 million is level with the FY 2020 Enacted. 

SAMHSA will use these funds for the SPARS and EBPRC contracts.

Mechanism Table for Performance and Quality Information Systems

(Dollars in thousands)

Program Activity

FY 2019 

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

No. Amount No. Amount No. Amount

Performance and Quality Information Systems

Contracts

Continuations.......................................................... 2 10,000 2 9,190 1 2,944 

New/Competing...................................................... --- --- --- 810 1 7,056 

Subtotal............................................................... 2 10,000 2 10,000 2 10,000 

Total, Performance and Quality Information Systems 2 10,000 2 10,000 2 10,000 
289

The following table provides a detailed description of all funding sources supporting CBHSQ 

activities.

Center for Behavioral Health Statistics and Quality

Breakout by Activity/Program (all sources)

(Dollars in thousands)

FY 2019 

Enacted

FY 2020 

Enacted

 FY 2021 

President's 

Budget

FY 2021 

President's 

Budget

+/- 

FY 2020 

Enacted

Substance Abuse Treatment Appropriation

Substance Abuse Block Grant Set Aside

Population Data Collection, Analysis, and Dissemination...................... $45,087 $42,212 $44,021 $1,808

PHS Evaluation (non add)..................................................................... 45,087 42,212 44,021 1,808

Treatment Services Data Collection, Analysis, and Dissemination ...... 5,496 7,724 5,701 -2,023

PHS Evaluation (non add)..................................................................... 5,496 7,724 5,701 -2,023

Behavioral Health Data Dissemination....................................................... 324 381 357 -24

PHS Evaluation (non add)..................................................................... 324 381 357 -24

Innovation and Logistical Services Support............................................. 3,277 --- --- ---

PHS Evaluation (non add)...................................................................... 3,277 --- --- ---

Support ........................................................................................................... 4,193 5,284 5,510 226

PHS Evaluation (non add)..................................................................... 4,193 5,284 5,510 226

Total Substance Abuse Block Grant Set Aside 58,377 55,601 55,588 -13

Total Substance Abuse Treatment PHS Evaluation 58,377 55,601 55,588 -13

Health Surveillance and Program Support Appropriation

Health Surveillance

Population Data Collection, Analysis, and Dissemination...................... 15,024 17,938 13,246 -4,693

PHS Evaluation (non add)...................................................................... 9,491 14,595 11,196 -3,399

Treatment Services Data Collection, Analysis, and Dissemination....... 13,710 23,103 14,302 -8,801

PHS Evaluation (non add)...................................................................... 11,512 13,626 14,302 675

Behavioral Health Data Dissemination....................................................... 324 619 693 74

PHS Evaluation (non add)...................................................................... 324 619 693 74

Performance Measurement/Systems........................................................... 462 299 1,065 766

PHS Evaluation (non add)...................................................................... 167 --- 873 873

Program Evaluations...................................................................................... 750 750 --- -750

PHS Evaluation (non add)...................................................................... 750 750 --- -750

Evidence-Based Programs/Practices........................................................... 215 --- --- ---

PHS Evaluation (non add)...................................................................... --- --- --- ---

Drug Abuse Warning Network.................................................................... --- 2,845 3,061 217

PHS Evaluation (non add)...................................................................... --- --- 3,061 3,061

Innovation and Logistical Services Support............................................. 10,947 --- --- ---

PHS Evaluation (non add)...................................................................... 3,404 --- --- ---

Support............................................................................................................ 5,826 1,704 1,476 -228

PHS Evaluation (non add)...................................................................... 4,781 838 1,329 491

Total Health Surveillance 47,258 47,258 33,842 -13,416

Drug Abuse Warning Network 10,000 10,000 --- -10,000

PHS Evaluation (non add)...................................................................... --- --- 10,000 10,000

Total Drug Abuse Warning Network 10,000 10,000 10,000 ---

Performance and Quality Information Systems

Performance Measurement/Systems........................................................... 6,632 6,832 7,056 225

Program Evaluations...................................................................................... --- --- --- ---

Evidence-Based Programs/Practices........................................................... 1,785 2,000 2,000 ---

Behavioral Health Data Dissemination....................................................... --- --- --- ---

Innovation and Logistical Services Support............................................. --- --- --- ---

DAWN............................................................................................................. 1,009 483 259 -225

Support............................................................................................................ 574 685 685 ---

Total Performance and Quality Information Systems 10,000 10,000 10,000 ---

Behavioral Health Workforce Data and Development

Behavioral Health Workforce Data Development..................................... 1,000 1,000 1,000 ---

PHS Evaluation (non add)...................................................................... 1,000 1,000 1,000 ---

Total Behavioral Health Workforce Data and Development 1,000 1,000 1,000 ---

Total Health Surveillance and Program Support 68,258 68,258 54,842 -13,416

Total Health Surveillance and Program Support PHS Evaluation 31,428 31,428 42,453 11,025

Total Center for Behavioral Health Statistics and Quality $126,635 $123,859 $110,430 -$13,429
290

Program Support

(Dollars in thousands)

Program Activity

FY 2019

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

FY 2021 

President's 

Budget 

+/-

FY 2020 

Enacted

Program Support................................................... $79,000 $79,000 $73,043 -$5,957

Authorizing Legislation .............................................Section 501 of the Public Health Service Act

FY 2021 Authorization ..................................................................................................$73,043,000

Allocation Method .......................................................Direct Federal/Intramural, Contracts, Other

Eligible Entities.........................................................................................................Not Applicable

Program Description and Accomplishments

The Program Support budget supports the majority of SAMHSA staff who plan, direct, and 

administer SAMHSA’s programs, as well as business operations and processes, information 

technology, and overhead expenses, such as rent, utilities, and miscellaneous charges. In addition, 

this budget supports the Unified Financial Management System, which covers administrative 

activities such as human resources, information technology, and the centralized services provided 

by HHS and the Program Support Center. 

SAMHSA supported 494 Full Time Equivalents (FTEs) in FY 2019. SAMHSA is in the process 

of adding additional FTEs in to support staffing for areas such as the Office of the Chief Medical 

Officer and Cures implementation. Staff positions that are not covered through the Health 

Surveillance and Program Support appropriation are funded with Substance Abuse Prevention and 

Treatment and Mental Health Block Grant set-asides for activities associated with technical 

assistance, data collection, and evaluation. 

SAMHSA applies an estimated internal administrative charge for overhead expenses to all 

programs, projects, and activities.

 Funding History

Fiscal Year Amount

FY 2017

FY 2018

$77,000,000

$79,000,000

FY 2019 $79,000,000

FY 2020 $79,000,000

FY 2021 $73,043,000
291

Budget Request 

The FY 2021 President’s Budget request are $73.0 million, which is a decrease of $5.9 million from 

the FY 2020 Enacted. This level of funding will continue to cover personnel, overhead costs 

associated with 5600 Fishers Lane, including rent, the Federal Acquisition Service loan repayment 

program, and security charges. 

Mechanism Table for Program Support

(Dollars in thousands)

Program Activity

FY 2019 

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

No. Amount No. Amount No. Amount

Program Support

Contracts

Continuations..................................................... --- 79,000 --- 79,000 --- 73,043 

New/Competing................................................. --- --- --- --- --- ---

Subtotal.......................................................... --- 79,000 --- 79,000 --- 73,043 

Total, Program Support --- 79,000 --- 79,000 --- 73,043 
292

Public Awareness and Support

(Dollars in thousands)

Program Activity

FY 2019

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

FY 2021 

President's 

Budget 

+/-

FY 2020 

Enacted

Public Awareness and Support.................................. $13,000 $13,000 $11,572 -$1,428

Authorizing Legislation.........Sections 501, 509, 516, and 520A of the Public Health Service Act

FY 2021 Authorization ......................................................................................................Indefinite

Allocation Method ............................................................................................................. Contracts

Eligible Entities.........................................................................................................Not Applicable

Program Description and Accomplishments

A part of SAMHSA’s mission is to raise the public’s understanding of mental and substance use 

disorders, serve as an expert on mental and substance use disorders, lead public health efforts to 

advance the health of the nation, and inform and equip the healthcare workforce. SAMHSA’s Office 

of Communications (OC) staff ensure that the vital information, publications, and training materials 

produced through SAMHSA’s Centers and Offices are available to the healthcare workforce, people 

in treatment and recovery, people in crisis or in areas affected by disasters, SAMHSA grantees, and 

the general public. OC staff communicate information on mental and substance use disorders and 

products through various channels such as reaching the media via e-mail, press releases, and news 

bulletins; communicating via social media platforms such as Twitter, Facebook, and YouTube; 

posting messages on the samhsa.gov website; uploading documents on the SAMHSA Store 

(managed through the Public Engagement Platform contract), issuing e-blasts to subscribers; and 

answering inquiries through the Contact Center’s National Helpline. In addition, the OC staff 

manage SAMHSA events to interact with stakeholders, media organizations and the general public 

and assist in the development and execution of materials, products, and campaigns.

The OC media team evaluates and acts upon media inquiries; develops and issues press releases, 

news bulletins, and media advisories; provides in-house media support to the Centers and Offices, 

including traveling to events; builds relationships with representatives of the media; identifies and 

seeks corrections to inaccuracies about SAMHSA in media products, when necessary; works to add 

SAMHSA’s life-saving resources to journalistic and entertainment products; supports broad HHS 

and administration communications priorities; and collaborates with other departmental OpDivs.

OC manages SAMHSA’s social media presence on channels such as Facebook, Twitter, and 

YouTube. In addition to print and traditional media, social media messaging is now incorporated 

in communications plans and is employed daily to communicate messages about mental and 

substance use disorders and resources. OC has staff who specialize in monitoring social media 

conversations, writing social media messages, participating in twitter chats, and writing and posting 

blogs on SAMHSA.gov. This also includes a close collaboration within SAMHSA when a disaster 
293

occurs to quickly disseminate press releases and social media featuring SAMHSA’s Disaster 

Distress Helpline and links to relevant SAMHSA resources.

OC is responsible for managing the SAMHSA.gov website via the Web Management and Support 

contract. The contract provides enterprise-wide content and technical support for SAMHSA.gov 

and other related public-facing websites. Key activities include website operations and maintenance 

updates, development and enhancements, and Section 508 remediation. On a daily basis OC staff 

add, update, and manage content for the SAMHSA website, in addition to technical maintenance 

and enhancements as needed.

OC manages two other contracts: the Public Engagement Platform (PEP) contract and the Contact 

Center contract. The PEP is a large-scale information dissemination program. PEP provides the 

public and other stakeholders with one-stop, quick access to mental and substance use disorder 

prevention, treatment, and recovery information, materials, and services. It operates a customeroriented order fulfillment/distribution center, which includes an online store (store.SAMHSA.gov) 

and warehouse, the SAMHSA listserv and subscriber database system, and mobile applications. 

The Contact Center contract supports the National Helpline (1-800-662-HELP) and the 1-877-

SAMHSA-7 line. The National Helpline provides free, confidential treatment referral and 

information services in English and Spanish for individuals and families facing mental illness 

and/or substance use disorders. It is operational 365 days-a-year, 24/7. The 1-877-SAMHSA-7 line 

is the single point of entry for SAMHSA’s information services and is operated Monday through 

Friday, 8:00 am to 8:00 pm (except for federal holidays).

 Funding History

Fiscal Year Amount

FY 2017

FY 2018

$13,000,000

$13,000,000

FY 2019 $13,000,000

FY 2020 $13,000,000

FY 2021 $11,572,000

Budget Request

The FY 2021 President’s Budget request is $11.6 million, which is a decrease of $1.4 million from 

the FY 2020 Enacted. SAMHSA intends to fund 5 contracts that will allow SAMHSA to manage 

media relationships, maintain its web and social media presence, manage critical helplines, and 

deliver publications and resources. 
294

Mechanism Table for Public Awareness and Support

(Dollars in thousands)

Program Activity

FY 2019 

Final

FY 2020 

Enacted

FY 2021

President's 

Budget

No. Amount No. Amount No. Amount

Public Awareness and Support

Contracts

Continuations.............................................................. 3 3,869 5 13,000 3 5,795 

New/Competing.......................................................... 4 9,131 --- --- 2 5,777 

Subtotal................................................................... 7 13,000 5 13,000 5 11,572 

Total, Public Awareness and Support 7 13,000 5 13,000 5 11,572 
295

Outputs and Outcomes Table

Program: Public Awareness and Support

Measure

Year and Most Recent Result 

Target for Recent Result 

(Summary of Result)

FY 2020

Target

FY 2021

Target

FY 2021

Target

+/-

FY 2020

Target

4.4.12 Number of 

individuals referred for 

behavioral health treatment 

resources. (Output)

FY 2018: 693,921

Target: 600,000

(Target Exceeded)

650,000 650,000 Maintain

4.4.13 Number of 

interactions through phone 

inquiries, e-blasts, 

dissemination of SAMHSA 

publications, and total 

website hits. (Output)

FY 2018: 51,897,273

Target: 44,567,523

(Target Exceeded)

45,000,000 45,000,000 Maintain
296

Drug Control Program

Department of Health and Human Services

Substance Abuse and Mental Health Services Administration

(Dollars in millions)

Resource Summary

FY 2019

Final

FY 2020

Enacted

FY 2021

President's 

Budget

Drug Resources by Decision Unit and Function

Programs of Regional and National Significance

Substance Abuse Prevention.................................................. 205.469 206.469 96.985

Substance Abuse Treatment................................................... 460.677 479.677 364.677

Total Programs of Regional and National Significance............. 666.146 686.146 461.662

State Opioid Response Grants....................................... 1,500.000 1,500.000 1,585.000

Substance Abuse Prevention and Treatment Block Grant1

Prevention............................................................................... 371.616 371.616 371.616

Treatment................................................................................ 1,486.463 1,486.463 1,486.463

Total, Substance Abuse Prevention and Treatment Block Grant 1,858.079 1,858.079 1,858.079

Health Surveillance and Program Support2

Prevention............................................................................... 23.209 22.824 19.717

Treatment................................................................................ 92.837 91.297 78.87

Total, Health Surveillance and Program Support...................... 116.046 114.121 98.587

Total Funding................................................................................ $4,140.271 $4,158.346 $4,003.328

Drug Resources Personnel Summary

Total FTEs 356 428 429

Drug Resources as a Percent of Budget

Total Agency Budget $5,743.996 $5,883.996 $5,741.843

Drug Resources Percentage 72.1% 71.0% 70.0% 1

The Substance Abuse Prevention and Treatment Block Grant is split 20% to the Prevention function and 80% to the Treatment 

function.

2 The Health Surveillance and Program Support Appropriation funded activities are split between Mental Health and Substance 

Abuse as follows: The Drug Abuse Warning Network is allocated fully to substance abuse. Program Support, Health Surveillance 

and PQIS are split the same proportion as drug control to the overall SAMHSA budget as defined by the substance abuse portions 

divided by the mental health and substance abuse portions combined. Public Awareness and Support, Behavioral Health 

Workforce Data and Development and Data Request and Publication User Fees are allocated 50% to drug control activities. The 

drug control total for HSPS after these calculations is allocated between Prevention (20%) and Treatment (80%).
297

Drug Budget Split between Prevention and Treatment

(Dollars in thousands)

Substance Abuse Prevention

FY 2019

Final

FY 2020

Enacted

FY 2021 

President's 

Budget

Programs of Regional and National Significance (PRNS)

Strategic Prevention Framework............................................................... $119,484 $119,484 $10,000

Strategic Prevention Framework Rx (non-add)................................. 10,000 10,000 10,000

Federal Drug-Free Workplace.................................................................. 4,894 4,894 4,894

Minority AIDS.......................................................................................... 41,205 41,205 41,205

Sober Truth on Preventing Underage Drinking ......................................... 8,000 9,000 9,000

Center for the Application of Prevention Technologies............................... 7,493 7,493 7,493

Science and Service Program Coordination............................................... 4,072 4,072 4,072

Tribal Behavioral Health Grants................................................................. 20,000 20,000 20,000

SAP Minority Fellowship Program............................................................ 321 321 321

Total, Substance Abuse Prevention PRNS 205,469 206,469 96,985

Substance Abuse Prevention and Treatment Block Grant1 371,616 371,616 371,616

PHS Evaluation Funds (non-add).................................................... 15,840 15,840 15,840

Total, Substance Abuse Prevention and Treatment Block Grant 371,616 371,616 371,616

Health Surveillance and Program Support2

Health Surveillance 6,818 6,685 4,722

Budget Authority (non-add)............................................................. 2,428 2,381 333

PHS Evaluation Funds (non-add).................................................... 4,390 4,304 4,389

Program Support...................................................................................... 11,398 11,175 10,192

Public Awareness and Support.................................................................. 1,300 1,300 1,157

Performance and Quality Information Systems........................................... 1,443 1,415 1,395

Behavioral Health Workforce Data and Development................................ 100 100 100

PHS Evaluation Funds (non-add).................................................... 100 100 100

Drug Abuse Warning Network.................................................................. 2,000 2,000 2,000

PHS Evaluation Funds (non-add).................................................... 2,000 2,000 2,000

Data Request/Publication User Fees.......................................................... 150 150 150

Total, Health Surveillance and Program Support 23,209 22,824 19,717

Total, Substance Abuse Prevention $600,294 $600,909 $488,318

2

 The Health Surveillance and Program Support Appropriation funded activities are split between Mental Health and Substance Abuse as 

follows: The Drug Abuse Warning Network is allocated fully to substance abuse. Program Support, Health Surveillance and PQIS are 

split the same proportion as drug control to the overall SAMHSA budget as defined by the substance abuse portions divided by the 

mental health and substance abuse portions combined. Public Awareness and Support, Behavioral Health Workforce Data and 

Development and Data Request and Publication User Fees are allocated 50% to drug control activities. The drug control total for HSPS 

after these calculations is allocated between Prevention (20%) and Treatment (80%).

1 The Substance Abuse Prevention and Treatment Block Grant is split 20% to the Prevention function and 80% to the Treatment function.
298

Drug Budget Split between Prevention and Treatment (Continued)

(Dollars in thousands)

Substance Abuse Treatment

FY 2019

Final

FY 2020

Enacted

FY 2021 

President's 

Budget

Programs of Regional and National Significance (PRNS)

Opioid Treatment Programs/Regulatory Activities...................................... $8,724 $8,724 $8,724

Screening, Brief Intervention and Referral to Treatment ............................. 30,000 30,000 ---

Budget Authority (non-add)............................................................. 28,000 28,000 ---

PHS Evaluation Funds (non-add).................................................... 2,000 2,000 ---

Targeted Capacity Expansion.................................................................... 100,192 100,192 11,192

Medication-Assisted Treatment for Prescription Drug and Opioid 89,000 89,000 ---

Pregnant and Postpartum Women............................................................. 29,931 31,931 31,931

Improving Access to Overdose Treatment................................................. 1,000 1,000 1,000

Recovery Community Services Program.................................................... 2,434 2,434 2,434

Children and Family Programs................................................................... 29,605 29,605 29,605

Treatment Systems for Homeless .............................................................. 36,386 36,386 36,386

Minority AIDS ......................................................................................... 65,570 65,570 65,570

SAT Minority Fellowship Program............................................................ 4,789 4,789 4,789

Criminal Justice Activities.......................................................................... 89,000 89,000 89,000

Addiction Technology Transfer Centers..................................................... 9,046 9,046 9,046

Building Communities of Recovery............................................................ 6,000 8,000 8,000

Grants to Prevent Prescription Drug/Opioid Overdose Related Deaths....... 12,000 12,000 12,000

Peer Support TA Center........................................................................... --- 1,000 1,000

Treatment, Recovery, and Workforce Support......................................... --- 4,000 4,000

Emergency Department Alternatives to Opioids......................................... --- 5,000 5,000

Grants to Develop Curricula for DATA Act Waivers................................. --- --- 4,000

First Responder Training........................................................................... 36,000 41,000 41,000

Total, Substance Abuse Treatment PRNS 460,677 479,677 364,677

State Opioid Response Grants 1,500,000 1,500,000 1,585,000

Substance Abuse Prevention and Treatment Block Grant1 1,486,463 1,486,463 1,486,463

PHS Evaluation Funds (non-add).................................................... 63,360 63,360 63,360

Total, Substance Abuse Prevention and Treatment Block Grant 1,486,463 1,486,463 1,486,463

Tribal Behavioral Health Formula Grants2 --- --- ---

Health Surveillance 27,273 26,739 18,889

Prevention and Public Health Fund (non-add)................................ --- --- ---

Program Support...................................................................................... 45,592 44,699 40,770

Public Awareness and Support.................................................................. 5,200 5,200 4,629

PHS Evaluation Funds (non-add).................................................... 400 400 400

Drug Abuse Warning Network.................................................................. 8,000 8,000 8,000

PHS Evaluation Funds (non-add).................................................... 8,000 8,000 8,000

Data Request/Publication User Fees.......................................................... 600 600 600

Total, Health Surveillance and Program Support 92,837 91,297 78,870

Total, Substance Abuse Treatment $5,039,977 $5,057,437 $5,100,010

2 The Health Surveillance and Program Support Appropriation funded activities are split between Mental Health and Substance Abuse as 

follows: The Drug Abuse Warning Network is allocated fully to substance abuse. Program Support, Health Surveillance and PQIS are 

split the same proportion as drug control to the overall SAMHSA budget as defined by the substance abuse portions divided by the 

mental health and substance abuse portions combined. Public Awareness and Support, Behavioral Health Workforce Data and 

Development and Data Request and Publication User Fees are allocated 50% to drug control activities. The drug control total for HSPS 

after these calculations is allocated between Prevention (20%) and Treatment (80%).

1 The Substance Abuse Prevention and Treatment Block Grant is split 20% to the Prevention function and 80% to the Treatment function.
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Mission

The Substance Abuse and Mental Health Services Administration’s (SAMHSA) mission is to 

reduce the impact of substance abuse and mental illness on America’s communities. SAMHSA 

supports the President’s National Drug Control Strategy through a broad range of programs 

focusing on prevention, treatment and recovery from substance abuse. Major programs for 

FY 2021 will include the Substance Abuse Prevention and Treatment Block Grant, State Opioid 

Response Grants, competitive grant programs reflecting Programs of Regional and National 

Significance (PRNS) and Health Surveillance and Program Support. SAMHSA’s Centers for 

Substance Abuse Prevention (CSAP) and Substance Abuse Treatment (CSAT) as well as through 

SAMHSA’s Center for Behavioral Health Statistics and Quality (CBHSQ) and the Office of 

Communications administer these programs.

Methodology

SAMHSA distributes drug control funding into two functions: prevention and treatment. Both 

functions include a portion of funding from the Health Surveillance and Program Support (HSPS) 

appropriation. Within that the program is 20% prevention and 80% treatment.

The portion of the Health Surveillance and Program Support account attributed to the Drug Budget 

uses the following calculations: 

• The Drug Abuse Warning Network is allocated fully to substance abuse prevention and 

treatment.

• The Health Surveillance, Program Support, and PQIS portions of the HSPS appropriation

are divided between Mental Health and Substance Abuse using the same percentages splits 

as between the Mental Health and Substance Abuse (Prevention and Treatment)

appropriation amounts.

o The Drug Control portion is then split 20 percent/80 percent into the two functions, 

prevention and treatment, respectively. 

• The Public Awareness and Support, Behavioral Health Workforce Data and Development, 

and Data Request and Publication User Fees portion of the HSPS appropriation is divided 

evenly between Mental Health and Substance Abuse.

o The Drug Control portion is then split 20 percent/80 percent into the two functions, 

prevention and treatment, respectively.

The prevention function also includes all of the Substance Abuse Prevention appropriation, 

including the Substance Abuse Prevention Programs of Regional and National Significance, and 

20 percent of the Substance Abuse Prevention and Treatment Block Grant funds specifically 

appropriated for prevention activities from the Substance Abuse Treatment appropriation. 

The treatment function also includes the Substance Abuse Treatment appropriation, including the 

Substance Abuse Treatment Programs of Regional and National Significance, State Opioid 

Response Grants, and 80 percent of the Substance Abuse Prevention and Treatment Block Grant 

funds.
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Budget Summary

The FY 2021 President’s Budget, SAMHSA requests a total of $4.0 billion for drug control 

activities, a decrease of $155.0 million from the FY 2020 Enacted. 

The budget directs resources to activities that have demonstrated improved health outcomes and 

that increase service capacity. SAMHSA has four major drug-related decision units: Mental Health, 

Substance Abuse Prevention, Substance Abuse Treatment, and Health Surveillance and Program 

Support. 

Each decision unit is discussed below:

Substance Abuse Prevention

Programs of Regional and National Significance

Strategic Prevention Framework (PRNS non-add)

FY 2021 Request: $10.0 million

(Reflects a $109.5 million decrease from the FY 2020 Enacted)

SAMHSA’s Strategic Prevention Framework (SPF) grant programs support activities to help 

grantees build a solid foundation for delivering and sustaining effective substance abuse prevention 

services and reducing substance abuse problems. The Strategic Prevention Framework –

Partnerships for Success program addresses underage drinking among youth and young adults age 

12 to 20 and allows states to prioritize State-identified top data driven substance abuse target areas. 

See page 150 in the CSAP chapter for the start of the full description of this program.

Strategic Prevention Framework for Prescription Drugs (PRNS non-add)

Due to alarming trends related to prescription drug misuse and overdoses involving opioids, 

SAMHSA is prioritizing efforts to address prescription drug misuse. SAMHSA implemented the 

Strategic Prevention Framework for Prescription Drugs to raise awareness about the dangers of 

sharing medications and to work with pharmaceutical and medical communities on the risks of 

overprescribing to young adults. SAMHSA’s program focuses on raising community awareness 

and bringing prescription drug use prevention activities and education to schools, communities, 

parents, prescribers, and their patients. SAMHSA tracks reductions in opioid overdoses and the 

incorporation of prescription drug monitoring data into needs assessments and strategic plans as 

indicators of program success. SAMHSA plans to maintain this level of support for SPF Rx through 

FY 2021.

See page 151 in the CSAP chapter for the start of the full description of this program.
301

Budget Request 

The FY 2021 President’s Budget is $10.0 million, reflecting a decrease of $109.5 million from the 

FY 2020 Enacted. Funding for the SPF Rx program will be maintained in its entirety ($10.0 

million) for 25 continuation grants. Funding to support SPF PFS is eliminated. 

Federal Drug-Free Workplace (PRNS non-add)

FY 2021 Request: $4.9 million

(Reflects level funding from the FY 2020 Enacted)

SAMHSA’s activities related to the Federal Drug-Free Workplace support two principal activities 

mandated by Executive Order (E.O.) 12564 and Public Law (P.L.) 100-71. This include: 1) 

oversight of the Federal Drug-Free Workplace, aimed at the elimination of illicit drug use within 

Executive Branch agencies and the federally-regulated industries; and 2) oversight of the National 

Laboratory Certification Program (NLCP), which certifies laboratories to conduct forensic drug 

testing for federal agencies, federally-regulated industries; the private sector also uses the HHSCertified Laboratories. 

See page 154 in the CSAP chapter for the start of the full description of this program.

Budget Request

The FY 2021 President’s Budget is $4.9 million, level with the FY 2020 Enacted. In FY 2021, 

SAMHSA will continue oversight of the Executive Branch Agencies’ Federal Drug-Free 

Workplace Programs. This includes review of Federal Drug-Free Workplace plans from those 

federal agencies that perform federal employee testing, random testing of those designated testing 

positions of national security, public health, and public safety, and testing for illegal drug use and 

the misuse of prescription drugs. SAMHSA will continue its oversight role for the inspection and 

certification of the HHS-certified laboratories. 

Sober Truth on Preventing Underage Drinking (PRNS non-add)

FY 2021 Request: $9.0 million

(Reflects level funding from the FY 2020 Enacted)

The Sober Truth on Preventing Underage Drinking Act (STOP Act) of 2006 (Public Law 109 - 422) 

was the nation’s first comprehensive legislation on underage drinking. One of the primary 

components of the STOP Act is the community-based coalition enhancement grant program, which 

provides up to $50,000 per year over four years to current or former grantees under the Drug Free 

Communities Act of 1997 to prevent and reduce alcohol use among youth under the age of 21. The 

STOP Act grant program enables organizations to strengthen collaboration and coordination among 

stakeholders to achieve a reduction in underage drinking in their communities. The STOP Act was 

reauthorized in the 21st Century Cures Act.

See page 161 in the CSAP chapter for the start of the full description of this program.
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Budget Request 

The FY 2021 President’s Budget is $9.0 million, level with the FY 2020 Enacted. In FY 2021, 

SAMHSA will support 101 STOP Act grant continuations and 17 new grants.

Centers for the Application of Prevention Technologies (PRNS non-add)

FY 2021 Request: $7.5 million

(Reflects level funding from the FY 2020 Enacted)

In 2019, Center for the Application of Prevention Technologies (CAPT) changed how it delivered 

services and began providing science-based training and technical assistance through Prevention 

Technology Transfer Centers (PTTC) cooperative agreements. SAMHSA leadership established 

the PTTC the previous year to expand and improve implementation and delivery of effective 

substance abuse prevention interventions, and provide training and technical assistance 

services to the substance abuse prevention field. The PTTC does this by developing and 

disseminating tools and strategies needed to improve the quality of substance abuse prevention 

efforts; providing intensive technical assistance and learning resources to prevention 

professionals in order to improve their understanding of prevention science, epidemiological 

data, and implementation of evidence-based and promising practices; and, developing tools 

and resources to engage the next generation of prevention professionals. 

See page 165 in the CSAP chapter for the start of the full description of this program.

Budget Request 

The FY 2021 President’s Budget is $7.5 million, level with the FY 2020 Enacted. Prevention T/TA 

services are being conducted by the PTTCs.

Science and Service Program Coordination (PRNS non-add)

FY 2021 Request: $4.1 million

(Reflects level funding from the FY 2020 Enacted)

The Science and Service Program Coordination program funds the provision of technical assistance 

and training to states, tribes, communities, and grantees around substance abuse prevention. 
303

Specifically, the program supports the Tribal Training and Technical Assistance Center and the 

Underage Drinking Prevention Education Initiatives (UADPEI). 

See page 168 in the CSAP chapter for the start of the full description of this program.

Budget Request

The FY 2021 President’s Budget is $4.1 million, level with the FY 2020 Enacted. This funding 

will support SAMHSA’s substance abuse prevention efforts and include a focus on preventing 

underage drinking and providing technical assistance and training to American Indians/Alaska 

Native communities. 

Tribal Behavioral Health Grants (PRNS non-add)

FY 2021 Request: $20.0 million

(Reflects level funding from the FY 2020 Enacted)

SAMHSA’s Tribal Behavioral Health Grants (TBHG) program addresses the high incidence of 

substance abuse and suicide among AI/AN populations. Starting in FY 2014, this program supports 

tribal entities with the highest rates of suicide by providing effective and promising strategies that 

address substance abuse, trauma, and suicide and by promoting the mental health of AI/AN young 

people.

See page 172 in the CSAP chapter for the start of the full description of this program.

Budget Request

The FY 2021 President’s Budget is $20.0 million, level with the FY 2020 Enacted. This request, 

along with $20.0 million in the Center of Mental Health Services will continue to support 

approximately 179 grants that promote mental health and prevent substance use activities for highrisk AI/AN youth and their families.
304

Performance

Prevention: Selected Measures of Performance 

Program

SPF: Partnerships for Success FY 2018 

Target

FY 2018 

Achieved

»

»

Increase the number of sub-recipient communities that 

improved one or more targeted NOMs indicators

Increase the number of EBPs implemented by sub-recipient 

communities

238

411

325

1,274

SPF: Rx FY 2017 

Target

FY 2017 

Achieved

» Increase the percent of funded states reporting reductions in 

opioid overdoses

55% 69%

STOP Act FY 2017 

Target

FY 2017

Achieved

» Increase the percent of coalitions that report at least a 5 percent 

improvement in the past 30-day use of alcohol in at least 2 

grades

62.0% 57.7%

» Increase the percent of coalitions that report improvement in 

youth perception of risk from alcohol in at least two grades

70% 75%

Tribal Behavioral Health Grants FY 2018 

Target

FY 2018 

Achieved

» Increase the number of programs/organizations that 

implemented specific mental health-related 

practices/activities as a result of the grant

5,670 7,219
305

Substance Abuse Treatment

Substance Abuse Prevention and Treatment Block Grant

FY 2021 Request: $1.9 billion

(Reflects level funding from the FY 2020 Enacted)

The Substance Abuse Prevention and Treatment Block Grant (SABG) program distributes funds to 

60 eligible states, territories and freely associated states, the District of Columbia, and the Red Lake 

Band of Chippewa Indians of Minnesota (referred to collectively as states) to plan, carry out, and 

evaluate substance use disorder prevention, treatment, and recovery support services for 

individuals, families, and communities impacted by substance misuse and substance use disorders. 

The SABG’s overall goal is to support and expand substance abuse prevention and treatment 

services while providing maximum flexibility to grantees. 

See page 260 in the CSAT chapter for the start of the full description of this program.

Budget Request

The FY 2021 President’s Budget is $1.9 billion, level with the FY 2020 Enacted. SABG funds will 

continue to serve as a source of safety net funding, including assistance to states in addressing the 

opioid epidemic, and will continue to support certain services (e.g., recovery support services) not 

covered by commercial insurance and non-clinical activities and services that address the critical 

needs of state substance abuse prevention and treatment service systems.
306

Performance

SAMHSA is undertaking a series of agency-wide efforts designed to develop a set of common 

performance, quality, and cost measures to demonstrate the impact of SAMHSA’s programs. 

Ultimately, SAMHSA and its state partners will collaborate to develop a streamlined behavioral 

health data system that complements other existing systems (e.g., Medicaid administrative and 

billing data systems, and state mental health and substance abuse treatment data systems), ensures 

consistency in the use of measures, and provides a more complete perspective of the delivery of 

mental illness and substance abuse treatment services.

An independent evaluation of the SABG demonstrated how states leveraged the statutory 

requirements to expand existing or establish new treatment capacity in underserved areas of states 

and territories and to improve coordination of services with other state systems.109 SAMHSA data 

show that on average, the SABG has been successful in expanding treatment capacity by annually 

supporting approximately two million110 admissions to treatment programs receiving public 

funding. Outcome data for the Block Grant program show positive results as reported through 

Behavioral Health Services Information System/Treatment Episode Data Set (TEDS) administered 

by SAMHSA’s Center for Behavioral Health Statistics and Quality. In FY 2019, at discharge, 

clients demonstrated above average abstinence rates from both illegal drug (56 percent) and alcohol 

(77 percent) use. State substance abuse authorities reported the following outcomes for services 

provided during FY 2019, the most recent year for which data is available:

State substance abuse authorities reported the following outcomes for services111 provided during 

FY 2019, the most recent year for which data is available:

• For the 50 states, American Samoa, the District of Columbia, Guam, Micronesia, Northern 

Marianas, and Puerto Rico that reported data concerning abstinence from alcohol use, 47 of 

the 58 identified improvements in client abstinence;

• Similarly, for the 55 states, American Samoa, the District of Columbia, Guam, Northern 

Marianas, and Puerto Rico that reported data concerning the abstinence from drug use, 40 

of 58 identified improvements in client abstinence;

• For the 49 states, American Samoa, the District of Columbia, Guam, Marshall Islands, 

Micronesia, Northern Marianas, the District of Columbia, Palau, Puerto Rico, and Red 

Lake that reported employments data, 51 of 58 identified improvements in client 

employment;

• For the 49 states, American Samoa, the District of Columbia, Guam, Micronesia, Northern 

Marianas, Palau, Puerto Rico, and Red Lake that reported criminal justice data, 51 of 57 

reported an increase in clients with no arrests based on data reported to TEDS; 

• For the 49 states, American Samoa, the District of Columbia, Guam, Northern Marianas, 

Palau, and Red Lake that reported housing data, 47 of 58 identified improvements in stable 

housing for clients based on data reported to TEDS; and 

 109 Substance Abuse and Mental health Administration. Retrieved from 

https://www.samhsa.gov/sites/default/files/grants/sapt-bg-evaluation-final-report.pdf. 110 Source: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services 

Administration, Treatment Episode Data Set (TEDS). Data received through 01 May 2018. 111 Services include services from Short-term residential, Long-term residential, Outpatient, and Intensive outpatient 

only.
307

• For the 44 states, the District of Columbia, Guam, Puerto Rico, and Red Lake that reported 

recovery support data, 45 states out of 48 identified improvements in client engagement in 

recovery support programs. 

Substance Abuse Prevention and Treatment Block Grant: 

Selected Measures of Performance 

Prevention Set-Aside

FY 2019

Target

FY 2019

Achieved

» Increase the percent of states showing a decrease in state 

level estimates of percent of survey respondents to report 

30 day use of other illicit drugs (age 12 – 17)

63.0% 63.0%

» Increase the percent of states showing a decrease in state 

level estimates of percent of survey respondents who 

report 30 days use of other illicit drugs (age 18+)

43.0% 43.0%

Treatment Activities

FY 2019

Target

FY 2019

Achieved

» Percentage of clients reporting no drug use in the past 

month at discharge.

74.0% 55.7%

» Increase the percentage of clients reporting being 

employed/in school at discharge.

40.0% 34.9%

» Increase the percentage of clients reporting no 

involvement with the criminal justice system.

92.0% 95.5%

» Increase the percentage of clients receiving services who 

had a permanent place to live in the community.

92.0% 87.8%
308

State Opioid Response

FY 2021 Request: $1.6 billion

(Reflects a $85.0 million increase from the FY 2020 Enacted)

Substance Abuse and Mental Health Services Administration established the State Opioid Response 

Grants (SOR) program in FY 2018. This program aims to address the opioid crisis by increasing 

access to medication-assisted treatment using the three FDA-approved medications for the 

treatment of opioid use disorder, reducing unmet treatment need, and reducing opioid overdose 

related deaths through the provision of prevention, treatment and recovery activities for opioid use 

disorder (OUD) (including prescription opioids, heroin and illicit fentanyl and fentanyl analogs). 

Funding was established to award up to 59 grants. These grants are awarded to states and territories 

via formula. The program also includes a 15 percent set-aside for the 10 states with the highest 

mortality rate related to drug overdose deaths. The allowable uses of this program will also be 

expanded to include state efforts to address stimulants, including methamphetamine, and cocaine. 

Stimulants are an increasing source of concern and are responsible for more deaths than opioids in 

a growing number of states, even as opioid over does deaths remain within 5% of their historic high 

last year.

See page 256 in the CSAT chapter for the start of the full description of this program.

Budget Request

The FY 2021 President’s Budget is $1.6 billion, an $85.0 million increase from the FY 2020 

Enacted. 

Programs of Regional and National Significance

Targeted Capacity Expansion (PRNS non-add)

The FY 2021 Request: $11.2 million

(Reflects a $89.0 million decrease from the FY 2020 Enacted)

The Targeted Capacity Expansion (TCE) program provides rapid, strategic, comprehensive, and 

integrated community-based responses to gaps in and capacity for SUD treatment and recovery 

support services. Examples of such needs include limited or no access to medication-assisted 

treatment (MAT) for opioid use disorders; lack of resources needed to adopt and implement health 

information technologies (HIT) in SUD treatment settings; and short supply of trained and qualified 

peer recovery coaches to assist individuals in the recovery process.

See page 192 in the CSAT chapter for the start of the full description of this program.
309

Budget Request

The FY 2021 President’s Budget is $11.2 million, a decrease of $89.0 million from the FY 2020 

Enacted. This will continue support for TCE-PTP and TCE-Special Projects, but will end grants 

associated with MAT-PDOA. These activities can be supported through the State Opioid Response 

grant program. SAMHSA will fund 23 TCE-Special Projects continuation grants and four new 

grants.

Opioid Treatment Programs/Regulatory Activities (PRNS non-add)

FY 2021 Request: $8.7 million

(Reflects level funding from the FY 2020 Enacted)

As part of its regulatory responsibility, SAMHSA certifies Opioid Treatment Programs that use 

methadone, buprenorphine, or buprenorphine/naloxone to treat patients with opioid dependence. 

SAMHSA carries out this responsibility by enforcing regulations established by an accreditationbased system. This is accomplished in coordination with the Drug Enforcement Administration, 

states, territories, and the District of Columbia. SAMHSA also funds the Opioid Treatment 

Programs Medical Education and Supporting Services project aimed at preparing Opioid Treatment 

Programs to achieve accreditation and providing technical assistance and clinical training to 

enhance program clinical activities. Additionally, SAMHSA funds grants and contracts that 

support the regulatory oversight and monitoring activities of Opioid Treatment Programs. 

See page 185 in the CSAT chapter for the start of the full description of this program.

Budget Request

The FY 2021 President’s Budget is $8.7 million, level with the FY 2020 Enacted. This request 

supports the Secretary’s five-prong strategy to address the opioid crisis priorities. In this program, 

this is through regulatory activities, ongoing training, certification, and technical assistance to 

provider groups and communities impacted by the opioid crisis.

Treatment Systems for Homeless (PRNS non-add)

FY 2021 Request: $36.4 million

(Reflects level funding from the FY 2020 Enacted)

SAMHSA’s Treatment Systems for Homeless portfolio supports services for those with substance 

use disorders and who are experiencing homelessness, including veterans, and those experiencing 

chronic homelessness. 

See page 210 in the CSAT chapter for the start of the full description of this program.
310

Budget Request

The FY 2021 President’s Budget is $36.4 million, level with the FY 2020 Enacted. This funding 

is to support grants to reduce homelessness for nearly 5,000 people. SAMHSA intends to fund 86 

GBHI continuation grants with grant supplements for direct technical assistance. 

Pregnant and Postpartum Women (PRNS non-add)

FY 2021 Request: $31.9 million

(Reflects level funding from the FY 2020 Enacted)

The Pregnant and Postpartum Women supports grants for residential treatment and the Pregnant 

and Postpartum Women Pilot, authorized in the Comprehensive Addiction and Recovery Act 

(CARA), helps state substance abuse agencies address the continuum of care, including services 

provided to women in nonresidential-based settings and promote a coordinated, effective and 

efficient state system managed by state substance abuse agencies by encouraging new approaches 

and models of service delivery. An evaluation of this program is underway to determine the 

effectiveness of the pilot. In FY 2018, SAMHSA funded three new state PPW pilot grants and three 

continuation state PPW pilot grants for program implementation, supplement for direct technical 

assistance, and one continuation evaluation contract. In FY 2019, SAMHSA funded six 

continuations grants. No new grants were funded. In FY 2020, SAMHSA plans to fund six PPW 

Pilot continuations, 39 PPW Residential continuations and four new PPW Residential programs.

See page 198 in the CSAT chapter for the start of the full description of this program.

Budget Request 

The FY 2021 President’s Budget is $31.9 million, level with the FY 2020 Enacted. SAMHSA 

intends to fund three PPW pilot continuations, three new pilot grants, 39 residential treatment grant 

continuations, to provide an array of services and supports to pregnant women and their children. 

Building Communities of Recovery (PRNS non-add)

FY 2021 Request: $8.0 million

(Reflects level funding from the FY 2020 Enacted)

In FY 2017, SAMHSA funded a new cohort of grant through the Comprehensive Addiction 

Recovery Act (CARA) Building Communities of Recovery program. The purpose of this program 

is to mobilize resources within and outside of the recovery community to increase the prevalence 

and quality of long-term recovery support from drug/alcohol addiction. These grants are intended 

to support the development, enhancement, expansion, and delivery of recovery support services 

(RSS) as well as promotion of and education about recovery. Programs are designed to be overseen 

by people in recovery from SUDs who reflect the community served. Grants support linkages 

between recovery networks and a variety of other organizations, systems, and communities, 

including: primary care, other recovery networks, child welfare system, criminal justice system, 

housing services and employment systems. Grantees will also work to reduce negative attitude, 

discrimination, and prejudice around addiction and addiction recovery. In FY 2018, SAMHSA 

funded 19 new grants, and provided continuation awards to five grants for a total of 24 BCOR 

grants. Moreover, these grantees received supplements for direct technical assistance. In FY 2019, 
311

SAMHSA funded five new BCOR awards and 23 BCOR continuation grants. In FY 2020, 

SAMHSA plans to fund five new grants and 22 continuation grants.

See page 224 in the CSAT chapter for the start of the full description of this program.

Budget Request 

The FY 2021 President’s Budget is $8.0 million, level with the FY 2020 Enacted. These funds will 

support 20 new grants and eight continuation grants for the Building Communities of Recovery 

program to develop, expand, and enhance recovery support services. 

Criminal Justice Activities (PRNS non-add)

FY 2021 Request: $89.0 million

(Reflects level funding from the FY 2020 Enacted)

SAMHSA’s Criminal Justice portfolio includes several grant programs that focus on diversion, 

alternatives to incarceration, drug courts, and re-entry from incarceration for adolescents and adults 

with substance use disorders and/or co-occurring substance use and mental disorders. This includes 

Treatment Drug Courts and the Offender Re-Entry Programs.

Drug Court Activities

FY 2021 Request: $70.0 million

(Reflects level funding from the FY 2020 Enacted)

SAMHSA’s Adult Drug Court programs support a variety of services including direct treatment 

services for diverse populations, wraparound/recovery support services designed to improve access 

and retention, drug testing for illicit substances, education support, relapse prevention and longterm management, pharmacotherapy), and HIV testing conducted in accordance with state and local 

requirements. The program seeks to address behavioral health disparities among racial and ethnic 

minorities by encouraging the implementation of strategies to decrease the differences in access, 

service use, and outcomes among the racial and ethnic minority populations served. In FY 2019, 

SAMHSA funded 46 new drug court grants, including one Tribe/Tribal organization, 134 drug 

court grant continuations, and one contract. In FY 2020, SAMHSA plans to fund 25 new drug court 

grants, at least 5 will be Tribes/Tribal organizations, pending sufficient applications, 156 drug court 

grant continuations, and one contract. 

See page 216 in the CSAT chapter for the start of the full description of this program.
312

Ex-Offender Re-Entry Program

FY 2021 Request: $19.0 million

(Reflects level funding from the FY 2020 Enacted)

In addition to the drug court portfolio, SAMHSA supports Offender Reentry Program (ORP) grants, 

as well as other criminal justice activities, such as evaluation and behavioral health contracts. These 

grants will provide screening, assessment, comprehensive treatment, and recovery support services 

for diverse populations reentering the community from incarceration. Other supported services 

include wraparound and recovery support services such as recovery housing and peer recovery 

support designed to improve access and retention, drug testing for illicit substances, educational 

support, relapse prevention and long-term management, and HIV and viral hepatitis B and C testing 

conducted in accordance with state and local requirements. In FY 2019, SAMHSA funded two 

new ORP grants and 32 ORP grant continuations. In FY 2020, SAMHSA plans to fund nine new 

ORP grants and 23 ORP grant continuations.

See page 219 in the CSAT chapter for the start of the full description of this program.

Budget Request

The FY 2021 President’s Budget is $89.0 million, level with FY 2020 Enacted. SAMHSA intends 

to support 54 new drug court grants, 92 drug court continuation grants, and one contract. SAMHSA 

intends to fund 11 new and five continuation ORP grants, and one contract.

First Responder Training (PRNS non-add)

FY 2021 Request: $41.0 million

(Reflects level funding from the FY 2020 Enacted)

First Responder Training supports efforts to help first responders and members of other key 

community sectors to administer a drug or device approved or cleared under the Federal Food, 

Drug, and Cosmetic Act for emergency treatment of known or suspected opioid overdose. Grantees

train and provide resources to first responders and members of other key community sectors at the 

state, tribal, and local governmental levels on carrying and administering a drug or device approved 

or cleared under the Federal Food, Drug, and Cosmetic Act for emergency treatment of known or 

suspected opioid overdose. Grantees also establish processes, protocols, and mechanisms for 

referral to appropriate treatment and recovery communities. Training, technical assistance, and 

evaluation activities are also being supported to assist grantees, determine best practices, and assess 

program outcomes. In FY 2018, SAMHSA awarded 14 new grants and 21 continuation grants. In 

FY 2019, SAMHSA funded 20 new grants and 34 continuation grants. In FY 2020, SAMHSA 

anticipates funding 58 continuation grants and four new grants.

See page 235 in the CSAT chapter for the start of the full description of this program.
313

Budget Request 

The FY 2021 President’s Budget is $41.0 million, level with the FY 2020 Enacted. SAMHSA plans 

to fund 14 new First Responder Training grants.

Grants to Prevent Prescription Drug/Opioid Overdose Related Deaths (PRNS non-add)

FY 2021 Request: $12.0 million

(Reflects level funding from the FY 2020 Enacted)

Opioid overdose is a significant contributor to accidental deaths among those who use, misuse, or 

abuse illicit and prescription opioids (including synthetics), such as fentanyl). SAMHSA’s Grants 

to Prevent Prescription Drug/Opioid Overdose Related Deaths program seeks to help states identify

communities of high need, and provide education, training, and resources necessary to tailor the 

overdose kits to meet their specific needs. Grantees can use the funds to purchase naloxone, equip 

first responders with naloxone and other overdose death prevention strategies, support education 

on these strategies, provide materials to assemble and disseminate overdose kits. In FY 2020, 

SAMHSA anticipates funding 12 continuation awards.

See page 238 in the CSAT chapter for the start of the full description of this program.

Budget Request

The FY 2021 President’s Budget is $12.0 million, level with the FY 2020 Enacted. This funding 

will provide 14 new grants to states to reduce the number of opioid overdose-related deaths. 

Funding will help states purchase overdose reversing drugs, equip first responders in high-risk 

communities, support education on the use of naloxone and other overdose-related death prevention 

strategies, provide the necessary materials to assemble overdose kits, and cover expenses incurred 

from dissemination efforts.
314

Other PRNS Treatment Programs (PRNS non-add)

FY 2021 Request: $42.1 million 

(Reflects level funding from the FY 2020 Enacted)

The FY 2021 Request includes resources of $42.1 million for several other Treatment Capacity 

programs including: Recovery Community Services Program; Children and Families; Improving 

Access to Overdose Treatment; and Addiction Technology Transfer Centers. The FY 2021 Request

includes funds for continuing grants and contracts in these programs. Grant funding will enhance 

overall drug treatment quality by incentivizing treatment and service providers to achieve specific 

performance targets. Examples of grant awards could include supplements for treatment and 

service providers who are able to connect higher proportions of detoxified patients with continuing 

recovery-oriented treatment; or for outpatient providers who are able to successfully retain greater 

proportions of patients in active treatment participation for longer periods. 

Grants to Develop Curricula for DATA Act Waivers (PNRS non-add)

FY 2021 Request: $4.0 million

(Reflects a $4.0 million increase from the FY 2020 Enacted)

The purpose of this new program, which is authorized by section 3203 of the SUPPORT for Patients 

and Communities Act, is to expand access to substance use disorder treatment by supporting grants 

to accredited schools of allopathic medicine or osteopathic medicine and teaching hospitals located 

in the United States to support the development of curricula that meet the requirements the 

Controlled Substances Act with respect to the treatment and management of opiate-dependent 

patients. 

See page 241 in the CSAT chapter for the start of the full description of this program.
315

Budget Request

The FY 2021 President’s Budget level is $4.0 million, an increase of $4.0 million from the FY 2020 

Enacted. This funding will support 117 grants.

Peer Support Technical Assistance Center (PRNS non-add)

FY 2021 Request: $1.0 million

(Reflects level funding from the FY 2020 Enacted)

The purpose of this new program, which is authorized by section 7152 of the SUPPORT for Patients 

and Communities Act (P.L. 115-271), is to provide funding for the creation of a National Peer-Run 

Training and Technical Assistance Center for Addiction Recovery Support, or the Center. The 

Center provides technical assistance and support to recovery community organizations and peer 

support networks. The technical assistance is related to training, translation and interpretation 

services, data collection, capacity building, and evaluation and improvement of the effectiveness of 

such services provided by recovery community organizations.

See page 242 in the CSAT chapter for the start of the full description of this program.

Budget Request

The FY 2021 President’s Budget is $1.0 million, level with the FY 2020 Enacted.

Treatment, Recovery, and Workforce Support (PRNS non-add)

FY 2021 Request: $4.0 million

(Reflects level funding from the FY 2020 Enacted)

The purpose of this new program, which is authorized by section 7081 of the SUPPORT for Patients 

and Communities Act, is to support the implementation of voluntary programs for care and 

treatment of individuals after a drug overdose, as appropriate, which may include utilizing recovery 

coaches, establishing policies and procedures that address the provision overdose reversal 

medication and FDA-approved medications to treat substance use disorders, and establishing 

integrated models of care for individuals who have experienced a non-fatal drug overdose. 

SAMHSA is directed, in consultation with the Secretary of Labor, to award competitive grants to 

entities to carry out evidence- based programs to support individuals in substance use disorder 

treatment and recovery to live independently and participate in the workforce.

See page 246 in the CSAT chapter for the start of the full description of this program.

Budget Request

The FY 2021 President’s Budget is $4.0 million, level with the FY 2020 Enacted.
316

Emergency Department Alternatives to Opioids (PRNS non-add)

FY 2021 Request: $5.0 million

(Reflects level funding from the FY 2020 Enacted)

The purpose of this new program, which is authorized by section 7091 of the SUPPORT for Patients 

and Communities Act (P.L. 115-271) is to provide funding to hospitals and emergency departments, 

including freestanding emergency departments, to develop, implement, enhance, or study 

alternative pain management protocols and treatments that limit the use and prescribing of opioids 

in emergency departments. In addition, these funds will be used to target common painful 

conditions, train providers and other hospital personnel, and provide alternatives to opioids for 

patients with painful conditions.

See page 244 in the CSAT chapter for the start of the full description of this program.

Budget Request

The FY 2021 President’s Budget is $4.0 million, level with the FY 2020 Enacted.

Performance

In the table below are selected measures of performance related to Treatment Programs of Regional 

and National Significance. The Treatment for Prescription Drug and Opioid Addiction exceeded its 

target outcome for reducing illicit drug use, but also surpassed its goals of increasing the number of 

clients receiving integrated care and the number of admissions for medication-assisted treatment. 

Though the target for the SBIRT outcome was not met, the program’s performance has improved. 

The drug court program not only exceeded its outcome goals, including for a reduction in past month 

drug use, but also exceeded its goals for the number of clients served. In FY 2017, more than 8,500 

adult clients were served by the adult drug court grant.

Treatment: Selected Measures of Performance 

Criminal Justice

FY 2019

Target

FY 2019

Achieved

» Drug Courts: Increase the percentage of adult clients 

receiving services who had no past month substance use

72.0% 87.3%

» Offender Reentry: Increase the percentage of adult clients 

receiving services who had no past month substance use

70.0% 62.2%
317

Health Surveillance and Program Support Appropriation

The FY 2021 Request is $98.6 million, a decrease of $15.5 million from the FY 2020 Enacted, 

which represents the Substance Abuse portion of the Health Surveillance and Program Support 

appropriation and supports staffing and activities to administer SAMHSA programs as described 

below.

Health Surveillance and Program Support 

FY 2021 Request: $74.6 million

(Reflects a $14.7 million decrease from the FY 2020 Enacted)

Health Surveillance and Program Support (HSPS) provides funding for personnel costs, building 

and facilities, equipment, supplies, administrative costs, and associated overhead to support 

SAMHSA programmatic activities, as well as provide funding for SAMHSA national data 

collection and survey systems, funding to support the Center for Disease Control and Prevention’s 

National Health Information Survey, and the data archive. This request represents the total funding 

available for these activities first divided between Mental Health and Substance Abuse using the 

same percentages splits that exist between the Mental Health and Substance Abuse (Prevention and 

Treatment) appropriation amounts. The Drug Control portion is then split 20 percent/80 percent 

into the two functions, prevention and treatment, respectively. 

See page 273 in the HSPS chapter for the start of the full description of this program.

Budget Request

The FY 2021 Request is $74.6 million, a decrease of $14.7 million from the FY 2020 Enacted. 

SAMHSA intends to continue funding the continuation of the NSDUH, BHSIS, SAMHDA, and 

EBPRC contracts and payroll Program Support funding will continue to cover overhead costs 

associated with 5600 Fishers Lane, including rent, the Federal Acquisition Service loan repayment 

program, and security charges. 

Public Awareness and Support 

FY 2021 Request: $5.8 million

(Reflects a 0.7 million decrease from the FY 2020 Enacted)

Public Awareness and Support provides funding to support the unified communications approach 

to increase awareness of behavioral health, mental disorders and substance abuse issues. This 

represents the total funding available for these activities first divided evenly between Mental Health 

and Substance Abuse. The Drug Control portion is then split 20 percent/80 percent into the two 

functions, prevention and treatment, respectively.

See page 291 in the HSPS chapter for the start of the full description of this program.
318

Budget Request

FY 2021 Request are $5.8 million, a decrease of $0.7 million from the FY 2020 Enacted. Funds for 

Public Awareness and Support will allow SAMHSA to fund 5 contracts that will allow SAMHSA 

to manage media relationships, maintain its web and social media presence, manage critical 

helplines, and deliver publications and resources. 

Performance and Quality Information Systems

FY 2021 Request: $7.0 million

(Reflects a $0.1 million decrease from the FY 2020 Enacted)

Performance and Quality Information Systems provides funding to support SAMHSA’s 

Performance Accountability and Reporting System (SPARs) related activities, as well as provide 

support for the National Registry of Evidence-based Programs and Practices that will reduce the 

backlog of interventions accepted but not reviewed under the previous contract. SPARS will 

provide a common data and reporting system for all SAMHSA discretionary grantees and allow 

programmatic technical assistance (TA) on use of the data to enhance grantee performance 

monitoring and improve quality of service delivery. This request represents the total funding 

available for these activities first split into Mental Health and Substance Abuse using the same 

percentages splits as between the Mental Health and Substance Abuse (Prevention and Treatment) 

appropriation amounts. The Drug Control portion is then split 20 percent/80 percent into the two 

functions, prevention and treatment, respectively.

See page 289 in the HSPS chapter for the start of the full description of this program.

Budget Request

The FY 2021 Request is $7.0 million, a decrease of $0.1 million from the FY 2020 Enacted. 

SAMHSA will use these funds to continue its performance management, quality improvement, and 

activities. This funding will ensure that SAMHSA continues a strong focus on developing and 

implementing evidence-based practices and programs and continues its emphasis on performance 

management for quality improvement and program monitoring. 

Drug Abuse Warning Network

FY 2021 Request: $10.0 million

(Reflects level funding from the FY 2020 Enacted)

DAWN is a nationwide public health surveillance system that will improve emergency department 

monitoring of substance use crises, including those related to opioids. Authorized by the 21st 

Century Cures Act, this program is necessary to respond effectively to the opioid and addiction 

crisis in the United States and to better inform public health, clinicians, policymakers, and other 

stakeholders to respond to emerging substance use trends. This request represents the total funding 

available for these activities. The Drug Abuse Warning Network is allocated fully to substance 

abuse.

See page 281 in the HSPS chapter for the start of the full description of this program.
319

Budget Request

The FY 2021 Request is $10.0 million, level with the FY 2020 Enacted. This funding will support 

the continuation of a contract awarded in 2018 and to fund the expansion of additional hospitals for 

FY 2021 to inform stimulant abuse prevention and response strategies. DAWN’s expansion to 

additional hospitals will allow for SAMHSA DAWN data-based estimates to be more generalizable 

and more representative across the country and will also allow SAMHSA to produce more accurate 

and complete assessment of geographic patterns (e.g. substance use disparities in urban, suburban 

and rural areas) and temporal trends (e.g. emerging or new substance misuse or abuse) in substance 

use related ED visits in the United States. 

Data Request and Publication User Fees

FY 2021 Request: $750,000

(Reflects level funding from the 2020 Enacted)

The FY 2021 Request is $750,000, level with the 2020 Enacted. SAMHSA will collect and retain 

fees for extraordinary data and publications requests. This represents the total funding estimated 

for these activities first divided evenly between Mental Health and Substance Abuse. The Drug 

Control portion is then split 20 percent/80 percent into the two functions, prevention and treatment, 

respectively.

Performance

Health Surveillance and Program Support: Selected Measures of Performance 

Public Awareness and Support

FY 2018 

Target

FY 2018 

Achieved

» Increase the number of individuals referred for behavioral

health treatment resources.

600,000 693,921

» Increase the total number of interactions through phone 

inquiries, e-blasts, dissemination of SAMHSA 

publications, and total website hits.

44,567,523 51,897,273
320

 SAMHSA

Supplementary Tables

Table of Contents

1. Budget Authority by Object Class.................................................................................. 320

2. Salaries and Expenses..................................................................................................... 329

3. Detail of Full-Time Equivalent (FTE) Employment ...................................................... 331

4. GAO-IG-Act ................................................................................................................... 332

5. Details of Positions......................................................................................................... 331

6. Programs Proposed for Elimination................................................................................ 334

7. Physicians’ Comparability Allowance (PCA) Worksheet.............................................. 336
321

Budget Authority by Object Classification Tables

Substance Abuse and Mental Health Services Administration

Total Budget Authority – Object Class

(Dollars in thousands)

Object Class - Direct Budget Authority1,2

FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

Personnel compensation:

Full-time permanent (11.1)............................................... $47,086 $48,310 $48,793 

Other than full-time permanent (11.3)............................ $2,018 $2,071 $2,091 

Other personnel compensation (11.5)............................ $1,234 $1,266 $1,279 

Military personnel (11.7).................................................. $3,383 $3,488 $3,593 

Special personnel services payments (11.8) ................ $18 $18 $19 

Subtotal personnel compensation: $53,740 $55,154 $55,775 

Civilian benefits (12.1)...................................................... $15,630 $16,015 $16,182 

Military benefits (12.2)..................................................... $1,782 $1,838 $1,893 

Subtotal Pay Costs: $71,152 $73,006 $73,850 

Travel and transportation of persons (21.0)................. $826 $839 $855 

Transportation of things (22.0)....................................... $5 $5 $5 

Rental payments to GSA (23.1)....................................... $5,233 $5,317 $5,418 

Rental payments to Others (23.2)................................... $--- $--- $--- 

Communication, utilities, and misc. charges (23.3)...... $462 $470 $478 

Printing and reproduction (24.0)..................................... $310 $315 $321 

Other Contractual Services:

Advisory and assistance services (25.1)...................... $33,349 $33,883 $34,526 

Other services (25.2)......................................................... $87,127 $85,784 $53,655 

 Purchase of Goods & Svcs. from Govt. Accts (25.3).. $35,619 $36,189 $36,877 

Operation and maintenance of facilities (25.4)............. $198 $201 $205 

Research and Development Contracts (25.5)............... $--- $--- $--- 

Operation and maintenance of equipment (25.7)......... $118 $120 $122 

Subtotal Other Contractual Services: $156,410 $156,176 $125,384 

Supplies and materials (26.0)........................................... $204 $207 $211 

Equipment (31.0)............................................................... $614 $624 $636 

Grants, subsidies, and contributions (41.0).................. $5,353,027 $5,499,870 $5,390,493 

Interest and dividends (43.0).......................................... $--- $--- $--- 

Subtotal Non-Pay Costs $5,517,092 $5,663,823 $5,523,802 

Total Direct Obligations $5,588,244 $5,736,829 $5,597,652 

1

 Does not include PHS EVAL Funds.

2

 Does not include Prevention and Public Health Funds.
322

Substance Abuse and Mental Health Services Administration

Mental Health Services

Budget Authority – Object Class

(Dollars in thousands)

Object Class - Direct Budget Authority1,2

FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

Personnel compensation:

Full-time permanent (11.1)................................................ $1,367 $1,403 $1,417 

Other than full-time permanent (11.3)............................. $26 $27 $27 

Other personnel compensation (11.5)............................ $17 $18 $18 

Military personnel (11.7).................................................. $--- $--- $--- 

Special personnel services payments (11.8) ................ $--- $--- $--- 

Subtotal personnel compensation: $1,411 $1,448 $1,462 

Civilian benefits (12.1)...................................................... $446 $458 $470 

Military benefits (12.2)..................................................... $--- $--- $--- 

Subtotal Pay Costs: $1,857 $1,905 $1,932 

Travel and transportation of persons (21.0)................. $196 $199 $203 

Transportation of things (22.0)....................................... $4 $4 $4 

Rental payments to GSA (23.1)....................................... $140 $142 $145 

Rental payments to Others (23.2)................................... $--- $--- $--- 

Communication, utilities, and misc. charges (23.3)...... $125 $127 $130 

Printing and reproduction (24.0)..................................... $126 $128 $130 

Other Contractual Services: $--- $--- 

Advisory and assistance services (25.1)....................... $15,557 $15,806 $16,107 

Other services (25.2)......................................................... $21,231 $21,571 $21,980 

 Purchase of Goods & Svcs. from Govt. Accts (25.3)... $13,658 $13,877 $14,141 

Operation and maintenance of facilities (25.4).............. $180 $183 $186 

Research and Development Contracts (25.5)................ $--- $--- $--- 

Operation and maintenance of equipment (25.7).......... $111 $113 $115 

Subtotal Other Contractual Services: $50,738 $51,550 $52,529 

Supplies and materials (26.0)........................................... $31 $32 $32 

Equipment (31.0)................................................................ $314 $319 $325 

Grants, subsidies, and contributions (41.0).................. $1,465,005 $1,590,568 $1,619,676 

Interest and dividends (43.0)........................................... $--- $--- $--- 

Subtotal Non-Pay Costs $1,516,678 $1,643,068 $1,673,175 

Total Direct Obligations $1,518,535 $1,644,974 $1,675,106 

1

 Does not include PHS EVAL Funds.

2

 Does not includes Prevention and Public Health Funds.
323

Substance Abuse and Mental Health Services Administration

Substance Abuse Prevention

Budget Authority – Object Class

 (Dollars in thousands)

Object Class - Direct Budget Authority1,2

FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

Personnel compensation:

Full-time permanent (11.1)................................................ $--- $--- $--- 

Other than full-time permanent (11.3)............................. $--- $--- $--- 

Other personnel compensation (11.5)............................ $--- $--- $--- 

Military personnel (11.7).................................................. $--- $--- $--- 

Special personnel services payments (11.8) ................. $--- $--- $--- 

Subtotal personnel compensation: $--- $--- $--- 

Civilian benefits (12.1)...................................................... $--- $--- $--- 

Military benefits (12.2)...................................................... $--- $--- $--- 

Subtotal Pay Costs: $--- $--- $--- 

Travel and transportation of persons (21.0).................. $--- $--- $--- 

Transportation of things (22.0)....................................... $--- $--- $--- 

Rental payments to GSA (23.1)....................................... $--- $--- $--- 

Rental payments to Others (23.2).................................... $--- $--- $--- 

Communication, utilities, and misc. charges (23.3)....... $--- $--- $--- 

Printing and reproduction (24.0)..................................... $121 $123 $125 

Other Contractual Services: $--- $--- 

Advisory and assistance services (25.1)....................... $5,137 $5,219 $5,318 

Other services (25.2)......................................................... $14,584 $14,818 $15,099 

 Purchase of Goods & Svcs. from Govt. Accts (25.3)... $5,036 $5,116 $5,213 

Operation and maintenance of facilities (25.4).............. $--- $--- $--- 

Research and Development Contracts (25.5)................ $--- $--- $--- 

Operation and maintenance of equipment (25.7).......... $--- $--- $--- 

Subtotal Other Contractual Services: $24,757 $25,153 $25,631 

Supplies and materials (26.0)........................................... $--- $--- $--- 

Equipment (31.0)................................................................ $82 $83 $84 

Grants, subsidies, and contributions (41.0)................... $180,510 $181,111 $71,145 

Interest and dividends (43.0)........................................... $--- $--- $--- 

Subtotal Non-Pay Costs $205,469 $206,469 $96,985 

Total Direct Obligations $205,469 $206,469 $96,985 

1

 Does not include PHS EVAL Funds.

2

 Does not include Prevention and Public Health Funds.
324

Substance Abuse and Mental Health Services Administration

Substance Abuse Treatment

Budget Authority – Object Class

(Dollars in thousands)

 

Object Class - Direct Budget Authority1,2

FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

Personnel compensation:

Full-time permanent (11.1)................................................ $3,117 $3,198 $3,230 

Other than full-time permanent (11.3)............................. $83 $86 $86 

Other personnel compensation (11.5)............................ $54 $55 $56 

Military personnel (11.7).................................................. $--- $--- $--- 

Special personnel services payments (11.8) ................. $--- $--- $--- 

Subtotal personnel compensation: $3,254 $3,338 $3,372 

Civilian benefits (12.1)...................................................... $1,015 $1,020 $1,030 

Military benefits (12.2)...................................................... $--- $--- $--- 

Subtotal Pay Costs: $4,269 $4,358 $4,402 

Travel and transportation of persons (21.0).................. $96 $97 $99 

Transportation of things (22.0)....................................... $--- $--- $--- 

Rental payments to GSA (23.1)....................................... $--- $--- $--- 

Rental payments to Others (23.2).................................... $--- $--- $--- 

Communication, utilities, and misc. charges (23.3)....... $22 $22 $23 

Printing and reproduction (24.0)..................................... $9 $9 $9 

Other Contractual Services: $--- $--- 

Advisory and assistance services (25.1)....................... $11,409 $11,592 $11,812 

Other services (25.2)......................................................... $12,916 $13,122 $13,372 

 Purchase of Goods & Svcs. from Govt. Accts (25.3)... $11,892 $12,082 $12,312 

Operation and maintenance of facilities (25.4).............. $18 $18 $19 

Research and Development Contracts (25.5)................ $--- $--- $--- 

Operation and maintenance of equipment (25.7).......... $1 $1 $1 

Subtotal Other Contractual Services: $36,236 $36,815 $37,515 

Supplies and materials (26.0)........................................... $ $ $ 

Equipment (31.0)................................................................ $106 $108 $110 

Grants, subsidies, and contributions (41.0)................... $3,694,672 $3,715,146 $3,686,399 

Interest and dividends (43.0)........................................... $--- $--- $--- 

Subtotal Non-Pay Costs $3,731,141 $3,752,198 $3,724,155 

Total Direct Obligations $3,735,410 $3,756,556 $3,728,556 

1

 Does not include PHS EVAL Funds.

2

 Does not include Prevention and Public Health Funds.
325

 Substance Abuse and Mental Health Services Administration

Health Surveillance and Program Support

Budget Authority – Object Class

(Dollars in thousands)

Object Class - Direct Budget Authority1,2

FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

Personnel compensation:

Full-time permanent (11.1)................................................ $42,602 $43,710 $44,147 

Other than full-time permanent (11.3)............................. $1,909 $1,958 $1,978 

Other personnel compensation (11.5)............................ $1,163 $1,193 $1,205 

Military personnel (11.7).................................................. $3,383 $3,488 $3,593 

Special personnel services payments (11.8) ................. $18 $18 $19 

Subtotal personnel compensation: $49,075 $50,368 $50,941 

Civilian benefits (12.1)...................................................... $14,169 $14,537 $14,682 

Military benefits (12.2)...................................................... $1,782 $1,838 $1,893 

Subtotal Pay Costs: $65,026 $66,743 $67,517 

Travel and transportation of persons (21.0).................. $534 $543 $553 

Transportation of things (22.0)....................................... $1 $1 $1 

Rental payments to GSA (23.1)....................................... $5,093 $5,175 $5,273 

Rental payments to Others (23.2).................................... $--- $--- $--- 

Communication, utilities, and misc. charges (23.3)....... $315 $320 $326 

Printing and reproduction (24.0)..................................... $54 $55 $56 

Other Contractual Services: $--- $--- 

Advisory and assistance services (25.1)....................... $1,246 $1,266 $1,290 

Other services (25.2)......................................................... $38,396 $36,273 $3,203 

 Purchase of Goods & Svcs. from Govt. Accts (25.3)... $5,033 $5,113 $5,211 

Operation and maintenance of facilities (25.4).............. $--- $--- $--- 

Research and Development Contracts (25.5)................ $--- $--- $--- 

Operation and maintenance of equipment (25.7).......... $6 $6 $6 

Subtotal Other Contractual Services: $44,680 $42,658 $9,710 

Supplies and materials (26.0)........................................... $172 $175 $179 

Equipment (31.0)................................................................ $113 $114 $117 

Grants, subsidies, and contributions (41.0)................... $12,840 $13,045 $13,272 

Interest and dividends (43.0)........................................... $--- $--- $--- 

Subtotal Non-Pay Costs $63,804 $62,088 $29,487 

Total Direct Obligations $128,830 $128,830 $97,004 

1

 Does not include PHS EVAL Funds.

2

 Does not include Prevention and Public Health Funds.
326

Substance Abuse and Mental Health Services Administration

Total PHS Evaluation Funds – Object Class

(Dollars in thousands)

Object Class - PHS Evaluation Funds

FY 

2019 

Final

FY 

2020 

Enacte

d

FY 2021 

President'

s Budget

Personnel Compensation:

 Full Time Permanent (11.1)................................................ $8,935 $10,435 $10,603 

 Other than Full-Time Permanent (11.3)........................... 506 566 578 

 Other Personnel Compensation (11.5)............................ 195 213 217 

 Military Personnel Compensation (11.7)........................ 343 459 473 

Special personnel services payments (11.8).................... --- --- ---

Subtotal Personnel Compensation: 9,980 11,673 11,871 

 Civilian Personnel Benefits (12.1).................................... 2,944 1,582 3,397 

 Military Personnel Benefits (12.2)................................. 285 161 247 

Subtotal Pay Costs: 13,209 13,416 15,514 

Travel (21.0)....................................................................... 33 34 34 

Transportation of things (22.0).......................................

Rental payments to GSA (23.1)....................................... --- --- ---

Communications, Utilities and Misc. Charges (23.3)... --- --- ---

Printing and Reproduction (24.0).................................... 427 434 439 

Other Contractual Services: 165 168 168 

Advisory and assistance services (25.1)....................... --- --- ---

Other services (25.2)......................................................... 84,717 85,812 95,141 

 Purchase of Goods & Svcs. from Govt. Accts (25.3)... 1,086 1,103 1,107 

Operation and maintenance of equipment (25.7).......... --- --- ---

Subtotal Other Contractual Services:............................. 85,803 86,915 96,248 

Supplies and Materials (26.0).......................................... 4 4 4 

Equipment (31.0)................................................................ 28 29 29 

Grants, Subsidies, and Contributions 

(41.0).......................................................................... 34,162 32,835 30,423 

Subtotal Non-Pay Costs 120,458 120,251 127,179 

Total Reimbursable Obligations

$133,66

7 

$133,66

7 $142,692 
327

Substance Abuse and Mental Health Services Administration

Mental Health Services

PHS Evaluation Funds – Object Class

(Dollars in thousands)

 

Object Class - PHS Evaluation 

FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

Personnel compensation:

Full-time permanent (11.1)............................................... $1,578 $1,728 $1,747 

Other than full-time permanent (11.3)............................ --- --- --- 

Other personnel compensation (11.5)............................ 24 24 24 

Military personnel (11.7).................................................. 107 110 113 

Special personnel services payments (11.8) ................ --- --- --- 

Subtotal personnel compensation: 1,708 1,862 1,884 

Civilian benefits (12.1)...................................................... 537 551 557 

Military benefits (12.2)..................................................... 61 63 65 

Subtotal Pay Costs: 2,306 2,476 2,506 

Travel and transportation of persons (21.0)................. 8 8 8 

Transportation of things (22.0).......................................

Rental payments to GSA (23.1)....................................... --- --- --- 

Communication, utilities, and misc. charges (23.3)...... --- --- --- 

Printing and reproduction (24.0)..................................... 257 261 266 

Other Contractual Services: --- --- --- 

Advisory and assistance services (25.1)...................... --- --- --- 

Other services (25.2)......................................................... 8,440 8,575 8,738 

 Purchase of Goods & Svcs. from Govt. Accts (25.3).. 33 34 34 

Operation and maintenance of equipment (25.7)......... --- --- --- 

Subtotal Other Contractual Services: 8,473 8,609 8,772 

Supplies and materials (26.0)........................................... 4 4 4 

Equipment (31.0)............................................................... --- --- --- 

Grants, subsidies, and contributions (41.0).................. 9,990 9,681 9,482 

Subtotal Non-Pay Costs 18,732 18,563 18,533 

Total Reimbursable Obligations $21,039 $21,039 $21,039 
328

Substance Abuse and Mental Health Services Administration

Substance Abuse Treatment

PHS Evaluation Funds – Object Class

(Dollars in thousands)

Object Class - PHS Evaluation 

FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

Personnel compensation:

Full-time permanent (11.1)............................................. $2,966 $3,123 $3,160 

Other than full-time permanent (11.3).......................... 94 96 97 

Other personnel compensation (11.5)......................... 61 62 63 

Military personnel (11.7)............................................... 174 180 185 

Special personnel services payments (11.8) .............. --- --- --- 

Subtotal personnel compensation: 3,295 3,461 3,505 

Civilian benefits (12.1)................................................... 947 952 961 

Military benefits (12.2)................................................... 95 98 101 

Subtotal Pay Costs: 4,337 4,511 4,567 

Travel and transportation of persons (21.0)............... 19 20 20 

Transportation of things (22.0).................................... --- --- --- 

Rental payments to GSA (23.1).................................... --- --- --- 

Communication, utilities, and misc. charges (23.3).... --- --- --- 

Printing and reproduction (24.0).................................. 171 173 174 

Other Contractual Services: --- --- 

Advisory and assistance services (25.1).................... --- --- --- 

Other services (25.2)...................................................... 52,245 53,081 53,238 

 Purchase of Goods & Svcs. from Govt. Accts (25.3) 229 232 233 

Operation and maintenance of equipment (25.7)....... --- --- --- 

Subtotal Other Contractual Services: 52,474 53,313 53,471 

Supplies and materials (26.0)........................................

Equipment (31.0)............................................................. 28 29 29 

Grants, subsidies, and contributions (41.0)................ 24,171 23,154 20,940 

Subtotal Non-Pay Costs 76,863 76,689 74,633 

Total Reimbursable Obligations $81,200 $81,200 $79,200 
329

Substance Abuse and Mental Health Services Administration

Health Surveillance and Program Support

PHS Evaluation Funds – Object Class

(Dollars in thousands)

Object Class - PHS Evaluation 

FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

Personnel compensation:

Full-time permanent (11.1).................................................. $4,392 $5,584 $5,697 

Other than full-time permanent (11.3)............................... 412 470 481 

Other personnel compensation (11.5).............................. 111 127 130 

Military personnel (11.7).................................................... 63 169 174 

Special personnel services payments (11.8) ................... --- --- --- 

Subtotal personnel compensation: 4,977 6,350 6,482 

Civilian benefits (12.1)........................................................ 1,460 79 1,879 

Military benefits (12.2)........................................................ 129 --- 81 

Subtotal Pay Costs: 6,566 6,429 8,442 

Travel and transportation of persons (21.0).................... 6 6 6 

Transportation of things (22.0)......................................... --- --- --- 

Rental payments to GSA (23.1)......................................... --- --- --- 

Communication, utilities, and misc. charges (23.3)......... --- --- --- 

Printing and reproduction (24.0)....................................... --- --- --- 

Other Contractual Services: 165 168 168 

Advisory and assistance services (25.1)......................... --- --- --- 

Other services (25.2)........................................................... 24,032 24,156 33,166 

 Purchase of Goods & Svcs. from Govt. Accts (25.3)..... 824 837 840 

Operation and maintenance of equipment (25.7)............ --- --- --- 

Subtotal Other Contractual Services: 24,856 24,993 34,005 

Supplies and materials (26.0)............................................. --- --- --- 

Equipment (31.0).................................................................. --- --- --- 

Grants, subsidies, and contributions (41.0)..................... --- --- --- 

Subtotal Non-Pay Costs 24,862 24,999 34,011 

Total Reimbursable Obligations $31,428 $31,428 $42,453 
330

Substance Abuse and Mental Health Services Administration

Salaries and Expenses Tables

Direct Budget Authority – Object Class

(Dollars in thousands)

Object Class - Direct Budget Authority1,2

FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

Personnel compensation:

Full-time permanent (11.1)................................................ $47,086 $48,310 $48,793 

Other than full-time permanent (11.3)............................. $2,018 $2,071 $2,091 

Other personnel compensation (11.5)............................ $1,234 $1,266 $1,279 

Military personnel (11.7).................................................. $3,383 $3,488 $3,593 

Special personnel services payments (11.8) ................. $18 $18 $19 

Subtotal personnel compensation $53,740 $55,154 $55,775 

Civilian benefits (12.1)...................................................... $15,630 $16,015 $16,182 

Military benefits (12.2)...................................................... $1,782 $1,838 $1,893 

Subtotal Pay Costs: $71,152 $73,006 $73,850 

Travel (21.0)........................................................................ $826 $839 $855 

Transportation of things (22.0)....................................... $5 $5 $5 

Rental payments to Others (23.2).................................... $--- $--- $--- 

Communication, utilities, and misc. charges (23.3)....... $462 $470 $478 

Printing and reproduction (24.0)..................................... $310 $315 $321 

Other Contractual Services:

Advisory and assistance services (25.1)....................... $33,349 $33,883 $34,526 

Other services (25.2)......................................................... $87,127 $85,784 $53,655 

 Purchase of Goods & Svcs. from Govt. Accts (25.3)... $35,619 $36,189 $36,877 

Operation and maintenance of facilities (25.4).............. $198 $201 $205 

Research and Development Contracts (25.5)................ $--- $--- $--- 

Operation and maintenance of equipment (25.7).......... $118 $120 $122 

Subtotal Other Contractual Services: $156,410 $156,176 $125,384 

Supplies and materials (26.0)........................................... $204 $207 $211 

Subtotal Non-Pay Costs $158,217 $158,012 $127,255 

Total Salary and Expenses $229,370 $231,018 $201,105 

Rental Payments to GSA (23.1)....................................... $5,233 $5,317 $5,418 

Grand Total, Salaries & Expenses and Rent $234,603 $236,335 $206,523 

Direct FTE....................................................... 491 606 615 1

 Does not include PHS EVAL Funds.

2

 Does not include Prevention and Public Health Funds.
331

Substance Abuse and Mental Health Services Administration

Salaries and Expenses Tables

PHS Evaluation Funds – Object Class

(Dollars in thousands)

Object Class1

FY 2019 

Final

FY 2020 

Enacted

FY 2021 

President's 

Budget

Personnel compensation:

Full-time permanent (11.1)........................................... $8,935 $10,435 $10,603 

Other than full-time permanent (11.3)........................ 506 566 578 

Other personnel compensation (11.5)....................... 195 213 217 

Military personnel (11.7)............................................. 343 459 473 

Special personnel services payments (11.8) ........... --- --- --- 

Subtotal personnel compensation 9,980 11,673 11,871 

Civilian benefits (12.1)................................................. 2,944 1,582 3,397 

Military benefits (12.2)................................................ 285 161 247 

Subtotal Pay Costs: 13,209 13,416 15,514 

Travel (21.0).................................................................. 33 34 34 

Transportation of things (22.0)..................................

Rental payments to Others (23.2).............................. --- --- --- 

Communication, utilities, and misc. charges (23.3). --- --- --- 

Printing and reproduction (24.0)................................ 427 434 439 

Other Contractual Services:

Advisory and assistance services (25.1).................. --- --- --- 

Other services (25.2).................................................... 84,717 85,812 95,141 

Purch. Goods & Svcs. Govt. Accts (25.3)................ 1,086 1,103 1,107 

Operation and maintenance of facilities (25.4)......... --- --- --- 

Research and Development Contracts (25.5)........... --- --- --- 

Operation and maintenance of equipment (25.7)..... 4 4 4 

Subtotal Other Contractual Services: 85,807 86,919 96,253 

Supplies and materials (26.0)...................................... 4 4 4 

Subtotal Non-Pay Costs 86,272 87,392 96,731 

Total Salary and Expenses 99,481 100,807 112,245 

Rental Payments to GSA (23.1).................................. --- --- --- 

Grand Total, Salaries & Expenses and Rent $99,481 $100,807 $112,245 

Reimbursable FTE...................................... 99 101 100

1

 Does not include Other reimbursable FTEs (30) and associated Object Class cost.
332

Substance Abuse and Mental Health Services Administration

Detail of Full Time Equivalent Employee (FTE)

 

 

 

FY 2019 

Actual 

Civilian

FY 2019 

Actual 

Military

FY 2019 

Actual 

Total

FY 2020 

Est. 

Civilian

FY 2020 

Est. 

Military

FY 2020 

Est. 

Total

FY 2021 

Est. 

Civilian

FY 2021 

Est. 

Military

FY 2021 

Est. 

Total

Health Surveillance and Program Support...

 Direct:.............................................................. 374 20 394 418 30 448 419 30 449

 Reimbursable:................................................. 23 3 26 39 4 43 40 4 44

 Total:............................................................. 397 23 420 457 34 491 459 34 493

Mental Health Services................................... 0 0 0

 Direct:.............................................................. 11 0 11 13 0 13 14 0 14

 Reimbursable:................................................. 13 3 16 20 2 22 22 2 24

 Total:............................................................. 24 3 27 33 2 35 36 2 38

Substance Abuse Prevention........................ 0 0 0

 Direct:.............................................................. 0 0 0 0 0 0 0 0 0

 Reimbursable:................................................. 11 2 13 21 1 22 21 1 22

 Total:............................................................. 11 2 13 21 1 22 21 1 22

Substance Abuse Treatment......................... 0 0 0

 Direct:.............................................................. 17 1 18 32 1 33 34 2 36

 Reimbursable:................................................. 12 1 13 24 1 25 25 1 26

 Total:............................................................. 29 2 31 56 2 58 59 3 62

SAMHSA FTE Total........................ 461 30 491 567 39 606 575 40 615
333

Substance Abuse and Mental Health Services Administration

Good Accounting Obligation in Government Act (GAO-IG Act) Report

Appendix 1: OIG-GAO Open Recommendations

Report 

Number

Report Title Report Date Recommendation Text Concur 

/ NonConcur

Implementation 

Timeline

Implementation 

Status

Implementation Updates and Constraints

GAO-15-

113

Mental Health: 

HHS Leadership 

Needed to 

Coordinate 

Federal Efforts 

Related to 

Serious Mental 

Illness 

2/5/2015 To help determine if 

programs are effective at 

supporting those individuals 

with serious mental illness, 

the Secretaries of Defense, 

Health and Human Services, 

Veterans Affairs, and the 

Attorney General--which 

oversee programs targeting 

individuals with serious 

mental illness--should 

document which of their 

programs targeted for 

individuals with serious 

mental illness should be 

evaluated and how often 

such evaluations should be 

completed.

NonConcur2020 In Progress HHS will be providing GAO with update by 

January 2020 and anticipate this 

recommendation being closed in early 2020. 

GAO-18-

32

Newborn 

Health: Federal 

Action Needed 

to Address 

Neonatal 

Abstinence 

Syndrome

10/4/2017 The Secretary of HHS 

should expeditiously 

develop a plan--that includes 

priorities, timeframes, clear 

roles and responsibilities, 

and methods for assessing 

progress--to effectively 

implement the NAS-related 

recommendations identified 

in the Protecting Our Infants 

Act: Final Strategy.

Concur 2020 In Progress An update was provided to GAO in October 

2019. GAO responded in November with a 

request additional information. HHS will 

provide GAO with additional information 

and anticipate that the recommendation will 

be closed in early 2020.

GAO-18-

450

Mental Health: 

Federal 

Procedures to 

Oversee 

Protection and 

Advocacy 

Program Could 

be Further 

Improved

5/24/2018 The Assistant Secretary for 

Mental Health and 

Substance Use should 

establish procedures to 

better ensure that midperformance changes to 

program priority goals, 

objectives, and targets are 

examined across multiple 

years.

Concur 2019 Awaiting 

Disposition

Latest update provided to GAO in October 

2019. HHS anticipates that recommendation 

will be closed by January 2020. 

GAO-18-

450

Mental Health: 

Federal 

Procedures to 

Oversee 

Protection and 

Advocacy 

Program Could 

be Further 

Improved

5/24/2018 The Assistant Secretary for 

Mental Health and 

Substance Use should take 

steps, including the steps it 

has planned, to ensure onsite 

reviews are completed and 

findings are provided to 

programs on a timely basis.

Concur 2019 Awaiting 

Disposition

Latest update provided to GAO in October 

2019. HHS anticipates that recommendation 

will be closed in early 2020. 
334

Substance Abuse and Mental Health Administration 

Detail of Positions

FY 2019

 Final

FY 2020

 Enacted

FY 2021

 President's Budget

Executive Level IV 1 1 1

Subtotal 1 1 1

Total - Exec Level Salaries $155,500 $155,500 $155,500

SES 10 20 20

Subtotal 10 20 20

Total, SES salaries $2,237,831 $4,475,662 $4,475,662

GM/GS-15/EE 53 64 64

GM/GS-14 108 122 122

GM/GS-13 168 205 205

GS-12 49 54 54

GS-11 22 27 27

GS-10 0 1 1

GS-09 12 25 27

GS-08 13 16 18

GS-07 18 20 22

GS-06 4 9 11

GS-05 3 3 3

GS-04 0 0 0

GS-03 0 0 0

GS-02 0 0 0

GS-01 0 0 0

Subtotal 450 546 554

Total, GS salaries $69,016,437 $83,739,944 $84,966,902

CC-08/09 0 1 1

CC-07 0 0 0

CC-06 14 18 18

CC-05 4 9 9

CC-04 9 9 9

CC-03 3 2 3

CC-02 0 0 0

CC-01 0 0 0

Subtotal 30 39 40

Total, CC salaries $4,741,346 $6,324,007 $6,687,232

Total Positions1 491 606 615

Average ES level ES ES ES

Average ES salary $155,500 $155,500 $155,500

Average SES level SES SES SES

Average SES salary $223,783 $223,783 $223,783

Average GS grade 13.6 13.6 13.6

Average GS salary $153,370 $153,370 $153,370

Average CC level 5 5 5

Average CC salaries $158,045 $162,154 $167,181
335

Programs Proposed for Elimination

The following table shows the programs proposed for elimination in the FY 2021 Budget Request. 

Terminations of these programs total $82 million in a single appropriations: Mental Health, Substance 

Abuse Prevention, and Substance Abuse Treatment. 

The following is a brief summary of the program and rational for the elimination proposal.

(Dollars in thousands)

Program 

FY 2020 

Enacted 

Primary and Behavioral Health Care Integration............... 49,877 

Primary and Behavioral Health Care Integration TA............. 1,991 

Screening, Brief Intervention and Referral to Treatment...... 30,000 

Total 81,868 

Primary and Behavioral Health Care Integration 

The Primary and Behavioral Health Care Integration (PBHCI) program began in FY 2009 to address 

specifically this intersection between primary care and mental disorder treatment. The program supports 

two activities: grants to community mental health centers and the PBHCI Training and Technical 

Assistance (TTA) Center, which is co-funded through a competitive cooperative agreement with the 

Health Resources and Services Administration (HRSA). These two activities collectively support the 

coordination and integration of primary care services into publicly funded community behavioral health 

settings for individuals with SMI and/or people with co-occurring disorders served by the public mental 

health system. PBHCI seeks to improve health outcomes for people with SMI by encouraging grantees to 

engage in necessary collaboration, expand infrastructure, and increase the availability of primary 

healthcare and wellness services for individuals with mental illness.

The Primary and Behavioral Healthcare Integration ($51.9 million) program is being proposed for 

elimination, as this program is potentially fundable through other sources of funds including the Substance 

Abuse Block Grant and Certified Community Behavioral health Center funding. SAMHSA will continue 

to disseminate the lessons learned from this program.

Screening, Brief Intervention and Referral to Treatment (SBIRT)

In 2003, SAMHSA started the Screening, Brief Intervention and Referral to Treatment (SBIRT) program, 

which is intended to help primary care physicians identify individuals who misuse substances and help 

them intervene early with education, brief treatment, or referral to specialty treatment. The program’s goal 

is to increase the number of individuals who receive treatment and reduce the rate of substance misuse. 

The SBIRT program seeks to increase the use of SBIRT in medical settings by promoting wide 

dissemination and adoption of the practice across the spectrum of primary care services. To achieve this, 

SAMHSA awards state implementation grants to encourage adoption of SBIRT by healthcare providers 

in each state. SAMHSA has demonstrated the effectiveness of SBIRT and continues to disseminate SBIRT 

practices.
336

SAMHSA is proposing to eliminate the SBIRT program ($30.0 million) as significant knowledge has been 

developed and disseminated for this program and it has been brought to scale in hundreds of communities 

across the nation. SAMHSA will continue to disseminate SBIRT program information as necessary. 
337

Physicians’ Comparability Allowance (PCA) Worksheet

Substance Abuse and Mental Health Services Administration

(Whole dollars)

1) Department and component: 

HHS/Substance Abuse and Mental Health Services Administration

2) Explain the recruitment and retention problem(s) justifying the need for the PCA pay authority. 

We have to offer PCAs because our salaries are not competitive with the private sector.

3-4) Please complete the table below with details of the PCA agreement for the following years:

FY 2019 

(Final) 

FY 2020 

(Enacted) 

FY* 2021 

(President’s Budget)

3a) Number of Physicians Receiving PCAs 1 1 1

3b) Number of Physicians with One-Year PCA Agreements - - -

3c) Number of Physicians with Multi-Year PCA Agreements 1 1 1

4a) Average Annual PCA Physician Pay (without PCA payment) 152,352 152,352 152,352

4b) Average Annual PCA Payment 16,000 16,000 16,000

*BY data will be approved during the BY Budget cycle. Please ensure each column is completed.

5) Explain the degree to which recruitment and retention problems were alleviated in your agency through the use of 

PCAs in the prior fiscal year. 

We have to offer PCAs because our salaries are not competitive with the private sector (e.g., we might offer 75% of a physician's 

salary on the outside). In addition, physicians of interest to SAMHSA often have income from consulting as well. The PCA is

the only way to raise the government income so as to make the offer acceptable.

 

6) Provide any additional information that may be useful in planning PCA staffing levels and amounts in your 

agency. 

N/A
338

SAMHSA FY21 CJ Significant Items

 Senate Appropriations Committee, Labor/HHS/Education Subcommittee (S. Rept. 116-000) 

 

 

1. Mental Health Directs SAMHSA to provide a comprehensive plan to the Committees identifying 

current gaps in mental healthcare programs, highlighting how these programs can help close 

those gaps, and providing recommendations to meet the needs of those experiencing mental illness. 

(Page 139 S. Report)

Action taken or to be taken

Overall, there are significant gaps in accessing treatment in the U.S. There are problems with 

variability in what types of treatment are available despite evidence demonstrating effectiveness 

and there are insufficient numbers of team based treatment providers that have the capacity or legal 

authority to follow up with challenging and high risk individuals who are gravely disabled by a 

SMI or SED. Services are too often fragmented and unavailable which results in suffering and 

adverse outcomes that could be avoided with adequate access, treatment, and follow up. SAMHSA 

will submit a plan to the House and Senate Appropriations Committees identifying current gaps in 

mental healthcare programs, highlighting how the programs can help close those gaps, and provide 

recommendations to meet the needs of those experiencing mental illness.

2. Infant & Early Childhood Mental Health Continues to recommend providing grants to entities 

such as state agencies, Tribal communities, university or medical centers that are in different 

stages of developing infant & early childhood mental health services.

(Page 140 S. Report)

Action taken or to be taken

In FY 2018, SAMHSA was appropriated $5 million for the Infant and Early Childhood Mental 

Health grant program and awarded 10 grants to universities and non-profit institutions based on 

the eligibility in Section 10006 of the 21st Century Cures Act. 

3. Mental Health Awareness Training SAMHSA is directed to include as eligible grantees local 

law enforcement agencies, fire departments, and emergency medical units with a special emphasis 

on training for crisis de-escalation techniques. SAMHSA is also encouraged to allow training for 

veterans, armed services personnel and their family members within the Mental Health First Aid 

program. (Page 141 S. Report)

Action taken or to be taken

SAMHSA included eligible grantees as directed. The Funding Opportunity Announcement (FOA) 

included as eligible grantees, local law enforcement agencies, fire departments, and emergency 

medical units with a special emphasis on training for crisis de-escalation techniques. In addition, 

the FOA allowable activities includes training for veterans, armed services personnel, and their 
339

family members. In FY 2020, SAMHSA anticipates funding the continuation of 156 Mental 

Health Awareness Training grants to entities including local law enforcement, fire departments, 

and emergency medical units.

4. National Suicide Prevention Hotline Requests that SAMHSA report to the Committees on the 

level of funding required to meet the needs of the hotline, given the increases in the rates of suicide 

and suicide attempts, and increased awareness and use of the hotline. (Page 141 S. Report)

Action taken or to be taken

The Budget includes $19 million for the suicide hotline which is the same as the 2020 Enacted 

level. SAMHSA continues to promote suicide prevention efforts through its Lifeline and 

associated follow up activities to connect callers with the needed help and care. SAMHSA looks 

forward to working with FCC on the implementation of the 988 national number.

5. Project AWARE The Committee provides $103,001,000, an increase of $32,000,000, for Project 

AWARE. This program increases awareness of mental health issues and connects young people 

that have behavioral health issues and their families with needed services. SAMHSA is encouraged 

to use funds to provide mental health services in schools and for school aged youth. Of the amount 

provided for Project AWARE, the Committee directs SAMHSA to use $10,000,000 for 

discretionary grants to support efforts in high crime, high-poverty areas and, in particular, 

communities that are seeking to address relevant impacts and root causes of civil unrest, 

community violence, and collective trauma. These grants should maintain the same focus as fiscal 

year 2019 grants. SAMHSA is encouraged to continue consultation with the Department of 

Education in administration of these grants. The Committee requests a report on progress of 

grantees 180 days after enactment.

(Page 141 S. Report)

Action taken or to be taken

In FY 2021 SAMHSA is proposing to use this funding to continue much needed services, supports, 

and training related to school-based mental health service provision. In addition, the funding will 

be used to continue an expansion of the AWARE model to rural communities. Funding will 

support increased access to services in rural schools through telehealth models, use of behavioral 

health aides, and linkages to services. In addition, funding would also be used to develop trainings 

in rural communities to for school personnel to recognize the signs and symptoms of mental illness 

in students.

SAMHSA continues to fund 11 Resilience in Communities After Stress and Trauma (ReCAST) 

grants for a total of $10 million. These grants support efforts in high crime, high-poverty areas 

and, in communities that are seeking to address relevant impacts and root causes of civil unrest, 

community violence, and collective trauma. SAMHSA looks forward to submitting a report on 

the progress of the ReCAST grantees.
340

6. Community Mental Health Services Block Grant Encourages SAMHSA to support State efforts 

to provide long-acting-injectable medications approved for the treatment of serious mental illness 

and assistance to those with severe mental health needs who are at risk of recidivism. Continues 

bill language requiring that at least 10 percent of the funds for the MHBG program be set-aside 

for evidence-based programs that address the needs of individuals with early serious mental 

illness, including psychotic disorders. Directs SAMHSA to continue its collaboration with NIMH 

to ensure that funds from this set-aside are only used for programs showing strong evidence of 

effectiveness and that target the first episode of psychosis. SAMHSA shall not expand the use of 

the set-aside to programs outside of the first episode psychosis. Directs SAMHSA to include in 

the FY 2021 CJ a detailed table showing at a min. each State's allotment, name of the program 

being implemented, and a short description of the program. (Page 142 S. Report)

Action taken or to be taken

SAMHSA will add a section in the Block Grant application encouraging states use of long-acting 

injectable medications and the benefits for those with serious mental illness. SAMHSA will also 

ask states to report on how they encourage providers to use long-acting-injectable medications 

approved for the treatment of serious mental illness and those who are at risk of recidivism. 

SAMHSA will continue to collaborate with National Institute of Mental Health (NIMH) regarding 

implementation of early Serious Mental Illness programs, including the research and resource 

materials. SAMHSA has provided in the FY 2021 CJ a detailed table identifying each States 

allotment, name of the program being implemented, and a short description of the program.

7. Children's Mental Health Services The Committee continues to include a 10 percent set-aside 

for an early intervention demonstration program with persons not more than 25 years of age at 

clinical high risk of developing a first episode psychosis. SAMHSA is directed to work with NIMH 

on the implementation of this set-aside. (Page 142 S. Report)

Action taken or to be taken

The Children’s Mental Health Services program provides grants and technical assistance to 

support comprehensive, community-based systems of care for children and adolescents with 

serious emotional, behavioral, or mental disorders. Grantees must provide matching funds and 

services must be coordinated with education, juvenile justice, child welfare, and primary 

healthcare systems. As part of the 10 percent set-aside, SAMHSA issued a Funding Opportunity 

Announcement for an early intervention demonstration program for individuals not more than 25 

years of age at clinical high risk of developing a first episode psychosis. SAMHSA will continue 

to collaborate with NIMH on the implementation of this program. In FY 2020, SAMHSA will 

support the continuation of the grants under the 10 percent set-aside. 

8. Certified Community Behavioral Health Clinics Directs SAMHSA to prioritize resources to 

entities w/in States that are part of the Protecting Access to Medicare Act of 2014 demonstration 

and to entities within States that were awarded planning grants. SAMHSA is directed to 
341

coordinate these resources with its efforts focusing on areas of high incidence of substance use 

disorders. Committee looks forward to receiving SAMHSA's first evaluation of the 

discretionary grant program in February of 2020. (Page 143 S. Report)

Action taken or to be taken

In FY 2020, SAMHSA released a new Funding Opportunity Announcement prioritized entities 

within states that are part of the Protecting Access to Medicare Act of 2014 demonstration and to 

entities within States that were awarded planning grants. In December 2019, SAMHSA provided 

to the Committee a Report to Congress and will provide an updated report in February 2020. 

9. Adolescent Substance Use Screening, Brief Intervention & Referral to Treatment [SBIRT] 

Encourages SAMHSA to use funds for the adoption of SBIRT protocols in primary care and other 

appropriate settings that serve youth 12 to 21 years of age as well as on the adoption of systemlevel approaches to facilitate the uptake of SBIRT into routine healthcare visits for adults. 

Encourages SAMHSA to consider using existing resources for grants to pediatric healthcare 

providers in accordance with the specifications outlined in Section 9016 of the Sober Truth in 

Preventing Underage Drinking Reauthorization. (Page 144 S. Report)

Action taken or to be taken

The Screening, Brief Intervention and Referral to Treatment (SBIRT) program is intended to help 

primary care physicians identify individuals who misuse substances and help them intervene early 

with education, brief treatment, or referral to specialty treatment. The SBIRT program seeks to 

increase the use of SBIRT in medical settings by promoting wide dissemination and adoption of 

the practice across the spectrum of primary care services. To achieve this, SAMHSA awards state 

implementation grants to encourage adoption of SBIRT by healthcare providers in each state. 

SAMHSA no longer proposes a dedicated program for SBIRT, but disseminates SBIRT as an 

evidence-based practice through its technology transfer centers, as well as through programs that 

treat youth with addiction and/or co-occurring substance abuse and mental disorders to address 

gaps in service delivery by providing services for youth and their families and primary caregivers 

using effective evidence-based, family-centered practices. 

10. Drug Courts Directs SAMHSA to ensure that all funding for Drug Treatment activities is 

allocated to serve people diagnosed with a substance use disorder as their primary condition. 

SAMHSA is further directed to ensure that all drug court recipients work with the corresponding 

State alcohol and drug agency in the planning, implementation, and evaluation of the grant. (Page 

145 S. Report)

Action taken or to be taken

Funding opportunity announcements for SAMHSA’s Drug Court grants state clearly that funds 

are intended to support individuals diagnosed with SUDs as their primary condition. SAMHSA’s 

Drug Court grantees are encouraged to work with the corresponding State Substance Abuse 

Agency in the planning, implementation, and evaluation of their grants. SAMHSA provides 
342

regional and national training and technical assistance to drug court grantees on evidence-based 

practices. 

11. Evidence-based Therapeutics Requests SAMHSA include a report in the FY 2021 CJ on how 

these new prescription technologies could be used by the behavioral health field as a tool to 

combat substance abuse and the opioid crisis by expanding patient access to treatment and 

recovery support services. (Page 145-146 S. Report)

Action taken or to be taken

SAMHSA is currently reviewing its Federal Guidelines for Opioid Treatment Programs (2015) for 

updates, including information about prescription digital health technologies to deliver evidencebased therapeutic interventions to patients.

12. Medication-Assisted Treatment The Committee continues to direct CSAT to ensure that these 

grants include as an allowable use the support of medication-assisted treatment and other 

clinically appropriate services to achieve and maintain abstinence from all opioids and heroin, 

including programs that offer low-barrier or same day treatment options. Notes that the report 

requested on this program has not yet been submitted and the Committee expects an update 

within 30 days of enactment. (Page 146 S. Report)

Action taken or to be taken

SAMHSA is requiring that for CSAT’s services programs, grants support medication-assisted 

treatment and other clinically appropriate services to achieve and maintain abstinence. The report 

to Congress on Medication Assisted Treatment is being finalized.

13. Opioid Abuse in Rural Communities Encourages SAMHSA to support initiatives to advance 

opioid abuse prevention, treatment, and recovery objectives, specifically focusing on addressing 

the needs of individuals with substance use disorders in rural and medically underserved areas. 

(Page 146 S. Report)

Action taken or to be taken

The First Responder Training program includes a funding set-aside for rural grantees to ensure 

that grant funding is distributed to rural and underserved areas. These grants are intended to train 

and support first responders in administering overdose reversal drugs. In addition, SAMHSA’s 

Rural Opioid Technical Assistance program, a program administered in partnership with the 

Department of Agriculture’s cooperative extension programs, provides technical assistance to 

assist rural communities in meeting critical needs related to the opioid crisis. 
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14. Opioid Detoxification Notes that opioid detoxification may be followed by injectable extendedrelease naltrexone, and encourages SAMHSA to disseminate information about this practice 

where applicable, including in rehabilitation and criminal justice settings. (Page 146 S. Report) 

Action taken or to be taken

SAMHSA updates its website to ensure that the most up-to-date information on naltrexone -- to 

include its uses and applicable settings -- is available to consumers and practitioners. A video for 

practitioners on the use and benefits of naltrexone is also being developed. 

15. (Page 147) Pregnant and Postpartum Women Program Encourages SAMHSA to prioritize 

States that support best-practice collaborative models for the treatment and support of pregnant 

women with opioid use disorders. (Page 147 S. Report)

Action taken or to be taken

Through the Pregnant and Postpartum Women (PPW) pilot program authorized by the 

Comprehensive Addiction and Recovery Act (CARA) of 2016, SAMHSA grants funds support 

family-based services for pregnant and postpartum women with a primary diagnosis of a substance 

use disorder, including opioid use disorders; help state substance abuse agencies address the 

continuum of care, including services provided to women in nonresidential-based settings; and 

support state substance abuse agencies by encouraging new approaches and models of service 

delivery. The funding opportunity announcement for this program places an emphasis on the use 

of evidence-based practices, in addition to building state infrastructure to support these services 

including ensure sustained partnerships across systems.

16. Sober Homes and Drug Treatment Facilities Encourages SAMHSA to provide information to 

local government officials regarding sober home best practices, including effective oversight of 

drug treatment facilities consistent with substance use disorder-specific program standards in an 

effort to protect vulnerable persons with substance use disorder, and their families, from 

fraudulent and abusive practices. (Page 147 S. Report)

Action taken or to be taken

In the fall of 2019, SAMHSA released guidance on its website entitled, Recovery Housing: Best 

Practices and Suggested Guidelines. The report provides guiding principles that will assist 

government officials in defining and understanding what comprises safe, effective and legal 

recovery housing, including sober homes. Best practices and minimum standards are described in 

the guiding principles. 

17. State Opioid Response Grants-- 2018 Report Committee is concerned that it has not received 

the report requested in fiscal year 2018 outlining detailed activities for which each State has 

received funding and the ultimate recipients of the funds provided to States and requests a report 

no later than 30 days after enactment. (Page 147 S. Report)

Action taken or to be taken

The State Opioid Response grants report is being finalized.
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18. State Opioid Response Grants-- Proposed Allocation of Funds The Committee recognizes the 

alarming increase in overdoses involving stimulants such as methamphetamine and cocaine 

across the country. CDC recently reported that during 2015–2016, age-adjusted death rates 

involving methamphetamine and cocaine increased by 52 percent and 33 percent respectively. As 

such, the Committee directs SAMHSA to make prevention and treatment of, and recovery from, 

stimulant abuse an allowable use of these funds while maintaining the existing formula calculation 

based on age adjusted mortality rates related to opioid overdose deaths. The Committee directs 

the agency to ensure funds reach local communities and counties to address areas of unmet need. 

SAMHSA is also directed to provide State agencies with technical assistance concerning how to 

enhance outreach and direct support to rural, underserved communities, and providers in 

addressing this crisis. SAMHSA shall submit to the Committees on Appropriations of the House of 

Representatives and the Senate the proposed allocation of funds not later than 15 days prior to 

publishing the funding opportunity announcement. (Page 147 S. Report)

Action taken or to be taken

SAMHSA plans to expand the scope of SOR to include addressing stimulant misuse in addition to 

opioids. The formula will continue to be based on the state’s proportion of people who meet 

criteria for dependence or abuse of heroin or pain relievers who have not received any treatment 

and the state’s proportion of drug poisoning deaths. SAMHSA will submit the proposed allocation 

of funds to the appropriations committees of the House and Senate at least 15 days prior to 

publishing the funding opportunity announcement.

19. State Opioid Response Grants—Evaluation In addition, the Committee looks forward to 

receiving SAMHSA’s evaluation of the program not later April 2020 and requests that SAMHSA 

update the evaluation on an annual basis. SAMHSA is directed to make the report and evaluation 

publicly available on SAMHSA’s website. (Page 147 S. Report)

Action taken or to be taken

In April 2020, SAMHSA will provide a report on the evaluation of the State Opioid Response 

program. 

20. Telehealth Medication-Assisted Treatment Pilot Project for Opioid Treatment Committee 

believes that the power of technology should be used to address the opioid epidemic and requests 

a report in the FY 2021 CJ on efficacy and sustainability of tele-MAT programs. (Page 147-148 

S. Report)

Action taken or to be taken

The State Opioid Response (SOR) program aims to increase access to medication-assisted 

treatment (MAT), reduce unmet treatment need, and reduce opioid overdose related deaths through 

the provision of prevention, treatment and recovery activities for opioid use disorder (OUD). In 

order to do so, states are required to develop and implement comprehensive systems of prevention, 

treatment, and recovery support services to address the opioid crisis. Since the SOR program’s 
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inception in 2018, states have engaged in numerous collaborations and developed innovations to 

increase access to MAT, particularly through the use of telehealth.

In the first year of the program, a number of states have utilized some form of telehealth in the 

delivery of MAT. For example, California has implemented the TeleWell Behavioral Medicine 

program to provide psychiatric and addiction medicine services using telehealth technology to 

rural and other underserved communities, especially tribal and urban Indian health programs. 

South Dakota is engaged in efforts to expand access to MAT statewide utilizing telehealth as it is 

predominantly rural and frontier; Oklahoma is engaged in a similar effort. 

As the activities of states are regularly monitored, SAMHSA will continually review the progress 

of states in their telehealth efforts to determine efficacy and provide technical assistance on 

sustainability beyond SOR funding. SAMHSA will also encourage information exchange between 

states on telehealth best practices. Additionally, SAMHSA will utilize its’ suite of technical 

assistance resources to disseminate information and best practices on telehealth, and provide 

technical assistance on implementation and evaluation of telehealth programs. 

21. Treatment, Recovery, and Workforce Support SAMHSA is directed to, in consultation with the 

Secretary of Labor, award competitive grants to entities to carry out evidence-based programs to 

support individuals in substance use disorder treatment and recovery to live independently and 

participate in the workforce. (Page 148 S. Report)

Action taken or to be taken

SAMHSA does not currently have a dedicated grant program for this activity. However, a many 

of SAMHSA’s services programs, such as the Recovery Community Services Program, promote 

evidence-based recovery support services that include, but are not limited to, employment 

coaching, recovery coaching, linkages to housing, recovery housing services and navigation 

services. Services programs also require that grantees report on clients’ improvement with regard 

to being employed or in school from intake to follow-up upon receiving treatment or services.

22. Tribal Behavioral Health Grants Urges the Assistant Secretary for Mental Health & Substance 

Abuse to engage with Tribes on ways to maximize participation in this program. (Page 149-150 

H. Report)

Action taken or to be taken

SAMHSA continues to fund the Tribal Behavioral Health grants also known as Native 

Connections. This program is designed to prevent suicide, substance misuse, reduce the impact of 

trauma, and promote mental health among American Indian/Alaska Native (AI/AN) youth through 

the age of 24 years. In addition, this grants help AI/AN communities to support youth and young 

adults as they transition into adulthood by facilitating collaboration among agencies. These grants 

are supported by the Native Connections Technical Assistance (TA) Center and the Mental Health 

Technology Transfer Center, National AI/AN Center. The Native Connections TA Center 

maximizes grantees participation in the grant program by ensuring that they have access to 

appropriate evidence-based and culturally informed-programs. This technical assistance helps 
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grantees shape and implement effective strategies to reduce the impact of mental illness and 

respond to the impact of trauma on AI/AN communities through a public health approach.

In addition, the SAMHSA Tribal Training and Technical Assistance Center provides support 

through site visits and Gatherings of Native Americans/Gatherings of Alaska Natives events. 

These efforts promote infrastructure development, capacity building, as well as program planning 

and implementation. 

23. Post-Traumatic Stress Disorder in First Responders Encourages SAMHSA to examine PTSD 

among this population, including prevalence rate, risk factors, symptom presentation, course, 

comorbidities, and rates of suicidal thoughts and actions, and to provide this information in the 

FY2021 CJ. (Page 150 H. Report)

Action taken or to be taken

Given the many natural and human-caused disaster our country has experienced in recent years, 

SAMHSA understands that the nation’s first responders are routinely exposed to severe and 

repeated trauma. SAMHSA funds the Disaster Technical Assistance Center (DTAC) to assist 

states, U.S. territories, tribes, and local providers plan for and respond to behavioral health needs 

after a disaster. SAMHSA continues to ensure that first responders have behavioral health 

resources in various formats to address these concerns. Three free, online trainings were designed 

to help first responders at any level, improve their awareness and understanding of the mental 

health and substance use risk factors to note in themselves and their peers, and how to seek support. 

Quarterly online newsletters and bulletins provide practical information on first responder care and 

support for disaster behavioral health coordinators, local service providers, federal agencies, and 

nongovernmental organizations.
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 House Appropriations Committee, Labor/HHS/Education Subcommittee (S. Rept. 116-62) 

1. PTSD in First Responders The Committee is aware of research indicating that individuals 

working in the civilian first responder disciplines of law enforcement, fire services, and emergency 

medical services are at greater risk for full or partial post-traumatic stress disorder (PTSD) than 

most other occupations because their responsibilities routinely entail confrontation with traumatic 

stressors. The Committee encourages SAMHSA to examine PTSD among this population, 

including prevalence rate, risk factors, symptom presentation, course, comorbidities, and rates of 

suicidal thoughts and actions. (Page 118 H. Report)

Action taken or to be taken

Given the many record-breaking natural and human-caused disaster our country has experienced 

in recent years, SAMHSA understands that the nation’s first responders are routinely exposed to 

severe and repeated trauma. SAMHSA funds the Disaster Technical Assistance Center (DTAC) to 

assist states, U.S. territories, tribes, and local providers plan for and respond to behavioral health 

needs after a disaster. SAMHSA continues to ensure that first responders have behavioral health 

resources in various formats to address these concerns. Three free, online trainings were designed 

to help first responders at any level, improve their awareness and understanding of the mental 

health and substance use risk factors to note in themselves and their peers, and how to seek support. 

Quarterly online newsletters and bulletins provide practical information on first responder care and 

support for disaster behavioral health coordinators, local service providers, federal agencies, and 

nongovernmental organizations.

2. Now is the Time/ School Mental Health Programs Encourages to sustain and strengthen grant 

to support school-based services aimed at mental health challenges, experienced by youth and 

young adults. (Page 118 H. Report)

Action taken or to be taken

SAMHSA believes that America’s schools should be safe and secure settings where children can 

focus on learning and develop their full potential; thus helping them stay on a positive trajectory 

that will support academic success and help them graduate and become productive citizens. Now 

is the Time (Project AWARE) supports several strategies for addressing mental health in schools: 

supports for mental wellness in education settings, building awareness of mental health issues, and 

early intervention with coordinated supports. The program also includes a focus on the specific 

needs affecting rural and tribal communities, which struggle with access to mental health services 

in schools and access to qualified health professionals to provide such services. To support school 

mental health, SAMHSA funds several program: AWARE-SEA grants, Mental Health Awareness 

Training grants, Resiliency in Communities After Stress and Trauma (ReCAST) grants, and 

technical assistance to develop school-based mental health models. 

3. Suicide Prevention The Committee urges SAMHSA to develop and disseminate programs to 

provide specialized training and resources on identifying and responding to people at risk of 
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suicide for families and friends of at-risk individuals. Given that the LGBTQ youth are more than 

four times more likely to attempt suicide then their peers, and that one in five LGBTQ youth and 

more than one in three transgender youth report attempting suicide this past year, SAMHSA must 

be equipped to provide specialized resources to this at risk community. (Page 118 H. Report)

Action taken or to be taken

In FY 2020, SAMHSA plans to develop and disseminate programs to provide specialized training 

and resources on identifying and responding to people at risk for suicide for families and friends 

of at risk individuals. This will include a Psychoeducational Toolkit for Families with a Loved 

One Who is Suicidal, as well as specialized resources for LGBTQ youth.

4. Suicide Prevention—data Committee requests that SAMSHA report the following: answer rates 

from each State, average wait time per State, how the Lifeline Centers are funded State-by-State, 

State-based resources per capita, total amount of funds spent on the suicide prevention lifeline by 

State, and how Congress can support the Lifeline’s State-based capacity challenges as demand 

continues to grow. (Page 118-119 H. Report)

Action taken or to be taken

SAMHSA is providing state by state answer rates for calls to the National Suicide Prevention 

Lifeline (excluding callers who press “one” for the Veterans Crisis Line). In FY 2020, SAMHSA 

will work with the National Suicide Prevention Lifeline to obtain average wait time per state, how 

the Lifeline centers are funded state by state, and total amount of funds spent on the National 

Suicide Prevention Lifeline crisis centers by state. The capacity to answer Lifeline calls by local 

crisis centers affects wait times.

5. Suicide Prevention -LGBTQ Competency The Committee urges SAMHSA to provide specific 

training programs for National Suicide Prevention Lifeline counselors to increase competency in 

serving LGBTQ youth through the utilization of existing specialized resources. The Committee 

also urges SAMHSA to consider the diversion of calls to specialty partners who are best situated 

to serve the LGBTQ community. (Page 119 H. Report)

Action taken or to be taken

In FY2020, SAMHSA will assure specific training is provided to the National Suicide Prevention 

Lifeline counselors to increase competency in serving LGBTQ youth. SAMHSA will also review 

options for the diversion of calls to specialty LGBTQ providers.

6. Mental Health Block Grant Expects continued collaboration with NIMH to encourage states to 

use block grant funding for programs w/ strong evidence of effectiveness. Directs a new 5% setaside for evidence-based crisis care programs. Directs inclusion in the FY21 budget a table 

showing state allotments, and description of the program. (Page 119-120 H. Report)
349

Action taken or to be taken

SAMHSA will continue to collaborate with National Institute of Mental Health (NIMH) to identify 

and support the implementation of evidence-based crisis intervention treatment services that aim 

to address the needs of persons with acute psychiatric crisis including those with acute suicide 

ideation. 

The 2021 Budget includes $35 million in the MHBG for evidence-based crisis care programs that 

provide persons in psychological distress timely and safe high quality care that stabilizes short 

term crises and will remain in contact with individuals until they are established in longer term 

care if needed. 

7. Criminal Justice Activities Strongly encourages to prioritize funding that assists those with 

severe mental health needs at risk of recidivism - especially in areas w/ high rates of 

uninsured/poverty/SUD. (Page 122 H. Report)

Action taken or to be taken

CSAT continues to fund its Drug Court grants and its Offender Reentry programs. These programs 

are designed to serve individuals with substance use disorders (SUDs) as their primary diagnosis. 

These grants may also serve individuals with co-occurring SUDs and mental disorders. However, 

CMHS’s criminal justice portfolio focuses on individuals with mental disorders and co-occurring 

SUDs as a primary population of focus. In FY 2018, CMHS awarded Law Enforcement 

Behavioral Health Partnerships for Early Diversion (Short Title: Early Diversion) grants, which 

divert adults with an SMI or a co-occurring disorder from the criminal justice system to 

community-based services prior to arrest and booking. For this program, in FY 2021, SAMHSA 

proposes to place a greater emphasis on those with SMI, who are at greater risk of becoming 

involved in the criminal justice system.

8. Emphasis on Comprehensive Services Committee directs the Department to continue its 

emphasis on evidence-based medical interventions, and to ensure that all such interventions, 

including programs that focus on harm reduction, provide referral to treatment and recovery 

services. (Page 123 H. Report)

Action taken or to be taken

SAMHSA continues to emphasize evidence-based medical interventions that promoted referral to 

treatment and recovery services. For example, SAMHSA’s criminal justice portfolio includes drug 

court grants that focus on diversion and alternatives to incarceration for adolescents and adults 

with drug/alcohol addiction and/or co-occurring drug/alcohol addiction and mental illness. The 

Offender Reentry Program (ORP) grants provide screening, assessment, comprehensive treatment, 

and recovery support services for diverse populations reentering the community from 

incarceration. Grantees are encouraged to use grant funds to provide medication-assisted treatment 

with FDA-approved medications. In July 2019, SAMHSA published an Evidence-based Practice 

Guidebook focused on medication-assisted treatment (MAT) implementation in criminal justice 

settings. 
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SAMHSA’s Improving Access to Overdose Treatment (CARA) grant program increases access to 

treatment, reduces unmet treatment need, and reduces opioid overdose related deaths. Grantees 

utilize SAMHSA’s Opioid Overdose Prevention Toolkit as a guide and includes a comprehensive 

prevention program that focuses on prevention, treatment, and recovery services to decrease the 

likelihood of drug overdose recurrence.

SAMHSA’s Substance Abuse Prevention and Treatment Block Grant (SABG) funds priority 

treatment and support services for individuals without insurance or for whom coverage is 

terminated for short periods of time. The SABG 20 percent primary prevention set-aside requires 

that grantees spend at least 20 percent of their SABG expenditures to develop and implement a 

comprehensive substance abuse prevention program. 

Additionally, SAMHSA, along with other HHS agencies, has developed guidance for grantees 

regarding use of grant funds to support syringe services programs, testing kits for HIV, navigation 

services to ensure linkage to HIV and viral hepatitis prevention, testing, treatment and care 

services, including antiretroviral therapy for HIV, pre-exposure prophylaxis (PrEP), post‐exposure 

prophylaxis (PEP), prevention of mother to child transmission and partner services; substance use 

disorder treatment, and medical and mental health care. 

9. Grants for Opioid Overdose Responder Urged use of grants for opioid responders and should 

include evidence-based intervention training. (Page 124 H. Report)

Action taken or to be taken

SAMHSA ensures that SABG recipients are addressing the opioid crisis by monitoring recipient’s 

adherence to their respective SABG application. The application explicitly states that “States 

continue to make primary substance use disorder prevention a priority. To respond to the primary 

prevention set-aside requirement of the SABG, states should keep in mind that the backbone of a 

prevention system is an infrastructure with the ability to collect and analyze epidemiological data 

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

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

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

and well-being in all communities.” Also, written in the application, “State authorities are strategic 

in leveraging scarce resources to fund prevention services.”

SAMHSA works with State authorities to ensure that they comport with changes in quality 

reporting. States are required to utilize the National Behavioral Health Quality Framework 

(NBHQF) as a mechanism for to examine, prioritize, and report on approaches to prevention, 

treatment, and recovery processes through the SABG as well as discretionary and formula 

grantees. As a result SAMHSA SABG funded recipients are able to utilize substance prevention 

block grant dollars for opioid safety education and training, including initiatives that improve 

access for licensed healthcare professionals, including paramedics, to emergency devices used to 

rapidly reverse the effects of opioid overdoses. 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 includes approved quality measures to assess outcomes and quality in 

programming. This effort guides and aligns the measurement requirements of Medicaid and 

Medicare. Also, SAMHSA continues to encourage SABG recipients to incorporate evidence-based 

intervention training and facilitate linkage to treatment and recovery services. 
351

The PTTC Network delivers training and technical assistance on practices that have proven 

effective in transferring knowledge and skills, tailored to the local needs of specific technical 

assistance recipients. A primary goal of the PTTC Network is to help prevention organizations 

make effective changes that produce measurable changes in outcomes. In addition, CSAP Project 

Officers during their monitoring calls (monthly for newer grantees) and quarterly, remind, as well 

as, continue to encourage grantees to be sure to incorporate evidence-based intervention training 

and to facilitate linkage to treatment and recovery services.

SAMHSA’s Grants to Prevent Prescription Drug and Opioid Overdose-related Deaths program 

helps states identify communities of high need and provide education, training, and resources 

necessary to meet their specific needs. Grant funds may be used for purchasing overdose reversing 

drugs, equipping first responders with them, providing training on their use, developing other 

overdose-related death prevention strategies, and providing materials to assemble and disseminate 

overdose kits. A growing evidence base suggests that overdose reversal drugs are a cost-effective 

method to reducing opioid overdose deaths. Grantees are also required to develop a dissemination 

plan and a training course tailored to meet the needs of first responders in their communities. The 

course uses SAMHSA’s Opioid Overdose Prevention Toolkit as a guide and includes a 

comprehensive prevention program that will focus on prevention, treatment, and recovery services 

in order to decrease the likelihood of drug overdose recurrence. SAMHSA also funds First 

Responder Training grants and Improving Access to Overdose Treatment grants, which also 

increase access to treatment, reduce unmet need, and reduce opioid overdose related deaths 

through the use of evidence-based training.

10. Pregnant & Postpartum Women Encourages to fund an additional cohort of states beyond those 

pilots already funded. (Page 124 H. Report)

Action taken or to be taken

SAMHSA intends to award an additional cohort of state grants for the PPW pilot program in FY 

2020.

11. Targeted Capacity Expansion Directed to include MAT to achieve abstinence from 

opioids/heroin. (Page 124 H. Report)

Action taken or to be taken

Funding for the MAT PDOA program is proposed to be discontinued in FY 2021. Support for 

MAT services may be continued through the SOR program. 

12. Addiction Treatment Centers Encourages comprehensive care for SU & MHD on site. (Page 

124 H. Report)

Action taken or to be taken

CSAT’s services grants provide treatment and recovery services to those with substance use 

disorders (SUDs) as their primary diagnoses, but also explicitly state that services are to be 

provided to those with co-occurring SUDs and mental disorders. Through CSAT’s programs,

authorized under its Programs of Regional and National Significance, CSAT addresses priority 

SUD treatment needs. In the absence of an authorization to provide mental health services, CSAT 

supports a comprehensive approach to addressing prevention, treatment, and recovery support for 
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individuals with SUD. For those with co-occurring SUD and mental disorders, CSAT promotes 

access and referral to mental health services and treatment where indicated. 

13. Continuum of Care Encouraged to work with state & local grantees to implement coordinated 

continuum of care approaches. (Page 125 H. Report)

Action taken or to be taken

SAMHSA continues to take a continuum of care approach to its substance use disorder treatment 

services programs, and in particular, to programs addressing the opioid crisis. One of SAMHSA’s 

primary efforts to address the opioid crisis, the State Opioid Response (SOR) program, was 

established to address the public health crisis caused by escalating opioid misuse and addiction 

across the nation. The SOR program provides resources to states, territories, and tribes to continue 

and enhance the development of comprehensive strategies focused upon preventing, intervening, 

and promoting recovery from problems related to opioid abuse. SOR grantees are required to use 

epidemiological data to demonstrate the critical gaps in availability of treatment for OUDs in 

geographic, demographic, and service level terms; utilize evidence-based implementation 

strategies to identify which system design models will most rapidly and adequately address the 

gaps in their systems of care; deliver evidence-based treatment interventions that include 

medication(s) FDA-approved specifically for the treatment of opioid use disorder (OUD), and 

psychosocial interventions; report progress toward increasing availability of medication-assisted 

treatment for OUD and reducing opioid-related overdose deaths.

14.Medication-Supported Therapy Encourages to implement in all settings where detoxification is 

offered. (Page 125 H. Report)

Action taken or to be taken

SAMHSA’s grant programs that directly respond to the opioid crisis increase access to medicationassisted treatment using FDA-approved medications for the treatment of opioid use disorder 

(OUD), reduce unmet treatment need, and reduce opioid overdose related deaths through the 

provision of prevention, treatment and recovery activities for OUD. In addition, SAMHSA 

requires that CSAT’s services programs addressing substance use disorders and co-occurring 

mental disorders – including its criminal justice programs – support medication-assisted treatment 

and other clinically appropriate services to achieve and maintain abstinence. Regarding the use of 

naltrexone following opioid detoxification, SAMHSA updates its website to ensure that the most 

up-to-date information on naltrexone -- to include its uses and applicable settings -- is available to 

consumers and practitioners. A video for practitioners on the use and benefits of naltrexone is also 

being developed.

15.Opioid Treatment Encourages to support approaches that consider needs of infants & mothers 

with SUD. (Page 125 H. Report)

Action taken or to be taken

SAMHSA continues to support the Pregnant and Postpartum Women (PPW) residential program, 

which seeks to expand comprehensive treatment, prevention and recovery support services for 

women and their children in residential substance use treatment facilities. The PPW program is 

intended to decrease the misuse of substances, including opioids; increase safe and healthy 
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pregnancies; improve birth outcomes; reduce perinatal and environmentally related effects of 

maternal and or paternal drug abuse on infants and children; improve the mental and physical 

health of women and children; and prevent mental, emotional, and behavioral disorders among 

children; among other objectives. The PPW pilot program authorized by the Comprehensive 

Addiction and Recovery Act (CARA) of 2016 supports family-based services for pregnant and 

postpartum women with a primary diagnosis of a substance use disorder, including opioid use 

disorders, in nonresidential settings.

16. Inpatient Treatment for Mental health Committee directs SAMHSA to study the impact of the 

inpatient hospital bed shortage on mental health and substance abuse treatment and recovery and 

provide those findings to the Committee within 90 days of enactment of this Act.

Action taken or to be taken

SAMHSA will conduct a study of the impact of the inpatient hospital bed shortage on mental 

health and substance abuse treatment and recovery in FY 2020. 

17.Criminal Justice Activities-- Drug treatment Courts Direct to ensure all drug treatment court 

grantees work directly with state substance abuse agency. Further directs expanding training & 

technical assistance to grantees to ensure evidence-based practices implemented. (Page 122 H. 

Report)

Action taken or to be taken

Funding opportunity announcements for SAMHSA’s Drug Court grants state clearly that funds 

are intended to support individuals diagnosed with SUDs as their primary condition. SAMHSA’s 

Drug Court grantees are encouraged to work with the corresponding State Substance Abuse 

Agency in the planning, implementation, and evaluation of their grants. SAMHSA provides 

regional and national training and technical assistance to drug court grantees on evidence-based 

practices. 
354

18.Sober Homes Urges to provide information on sober homes to communities dealing with opioid 

crisis. (Page 125 H. Report)

Action taken or to be taken

In the fall of 2019, SAMHSA released guidance on its website entitled, Recovery Housing: Best 

Practices and Suggested Guidelines. The report provides guiding principles that will assist 

government officials in defining and understanding what comprises safe, effective and legal 

recovery housing, including sober homes. Best practices and minimum standards are described in 

the guiding principles. 
355

SAMHSA

OPDIV Specific Requirements

PPHF

GLS – Youth Suicide 

Prevention- States (PPHF)

FY 2019 Final FY 2020 Enacted

PHS Eval Tap 300,000.00 300,000.00 

Grants 11,388,164.00 11,397,411.00 

CCB Tap 311,836.00 302,589.00 

Total $ 12,000,000.00 $ 12,000,000.00 

In fiscal year 2019, the Garret Lee Smith (GLS) Youth Suicide Prevention State and Tribal grant program 

was funded at $12 million from the Prevention and Public Health Fund and $ million from SAMHSA’s 

base budget. The GLS Memorial Act (Public Law 108-35) authorizes SAMHSA to award grants to states 

and manage this grant program through a competitive process. The GLS Youth Suicide Youth Suicide 

Prevention State and Tribal grant program develops and implements youth suicide prevention and early 

intervention strategies involving public-private collaborations among youth serving institutions.

SAMHSA’s evaluation of national youth suicide prevention efforts (age 10 to 24) have shown that 

counties implementing SAMHSA funded GLS youth suicide prevention activities have lower rates of 

youth suicide deaths than matched counties not implementing such activities. This impact is maintained 

for two years and the impact appears directly related to years of continued funding. Approximately 50 

percent of the counties in America have received at least one year of funding since the program started in 

2005. Since 2005 over 1.6 million individuals’ participated in over 39,000 training events or educational 

seminars provided by grantees. In FY 2019, 195,000 youth were screened for suicide risk, 30,362 youth 

were referred to services, and over 261,000 individuals were contacted through program outreach 

efforts. Grantees’ efforts are reducing the likelihood of at-risk youth falling through the gaps in the 

system.