OMB No. 0930-0168

 Expiration Date: 03/31/2025

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to 

respond to, a collection of information unless it displays a currently valid OMB control number. The 

OMB control number for this project is 0930-0168. Public reporting burden for this collection of 

information is estimated to average 188 hours per respondent, per year, including the time for 

reviewing instructions, searching existing data sources, gathering, and maintaining the data needed, and 

completing and reviewing the collection of information. Send comments regarding this burden 

estimate or any other aspect of this collection of information, including suggestions for reducing this 

burden, to SAMHSA Reports Clearance Officer, 5600 Fishers Lane, Room 15E57-B, Rockville, 

Maryland, 20857.

FFY 2022-2023 Block Grant 

Application

Community Mental Health Services Block Grant 

(MHBG) 

Plan and Report

Substance Abuse Prevention and Treatment Block 

Grant (SABG)

Plan and Report

U.S. Department of Health and Human Services 

Substance Abuse and Mental Health Services Administration
i

Table of Contents

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

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

B. Impact on State Authorities and Systems .............................................................................................. 2

C. Block Grant Programs’ Purposes .......................................................................................................... 8

II. SUBMISSION OF APPLICATION AND PLAN TIMEFRAMES ...................................................... 8

III. MENTAL AND SUBSTANCE USE DISORDER ASSESSMENT AND PLAN ............................. 11

A. Framework for Planning—Mental Health and Substance Use Prevention and Treatment ........... 11

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

C. Environmental Factors and Plan .................................................................................................... 42

1. Access to Care, Integration, and Care Coordination - Required ................................................... 42

2. Health Disparities - Required ........................................................................................................ 44

3. Innovation in Purchasing Decisions - Requested .......................................................................... 47

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

(ESMI)-10 percent set aside - Required for MHBG ..................................................................... 49

5. Person Centered Planning (PCP) -Required for MHBG ............................................................... 52

6. Program Integrity - Required ............................................................................................................... 54

7. Tribes - Requested ............................................................................................................................... 55

8. Primary Prevention - Required SABG ................................................................................................ 57

9. Statutory Criterion for MHBG - Required for MHBG ........................................................................ 68

10. Substance Use Disorder Treatment - Required for SABG ................................................................. 74

11. Quality Improvement Plan- Requested .............................................................................................. 84

12. Trauma -Requested ........................................................................................................................ 84
ii

13. Criminal and Juvenile Justice - Requested .................................................................................... 86

14. Medication Assisted Treatment - Requested (SABG only)........................................................... 87

15. Crisis Services - Required for MHBG ........................................................................................... 89

16. Recovery - Required ...................................................................................................................... 93

17. Community Living and the Implementation of Olmstead - Requested ......................................... 95

18. Children and Adolescents M/SUD Services - Required for MHBG, Requested for SABG ......... 97

19. Suicide Prevention - Required for MHBG .................................................................................. 100

20. Support of State Partners - Required for MHBG ........................................................................ 101

21. State Planning/Advisory Council and Input on the Mental Health/Substance Abuse Block Grant 

Application - Required for MHBG .............................................................................................. 103

22. Public Comment on the State Plan - Required ................................................................................ 107

Acronyms ................................................................................................................................................ 108

Resources ................................................................................................................................................ 112

1. Required Forms

a. Face Page—Community Mental Health Services Block Grant

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

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

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

Block Grant

e. Assurances
1

FFY 2022-2023 Block Grant Application

I. INTRODUCTION

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

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

1911-1920 of Title XIX, Part B, Subpart I of the Public Health Service Act (42 U.S.CF.§§ 300x300x-9) and sections 1921-1935 of Title XIX, Part B, Subpart II of the Public Health Service Act 

(42 U.S.C.§ 300x-21-35), respectively, and sections 1941-1956 of Title XIX, Part B, Subpart III 

of the Public Health Service Act (42 U.S.C.§§ 300x-51-66). This block grant application 

includes four major parts: introduction; submission of application and plan time frames; Mental 

and Substance Use Disorder (M/SUD) assessment and plan; and report requirements. These

sections include discussions and planning around the following policy topics: access to care, 

integration, and care coordination; health disparities; innovations in purchasing decisions; 

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

centered planning (PCP); program integrity; tribes; primary substance use disorder prevention, 

statutory criteria for MHBG; substance use disorder treatment; quality improvement; trauma; 

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

community living and Olmstead; children and adolescents M/SUD services; suicide prevention; 

support of state partners; state planning/advisory council; and public comment. It also includes

the planned expenditures for FY 2022-23 Consolidated Appropriations Act (COVID-19 Relief) 

Supplemental Funding and the FY 2022-23 American Rescue Plan (ARP) Supplemental 

Funding of MHBG and SABG grantees. 

A. Background

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

major block grants: The Substance Abuse Prevention and Treatment Block Grant (SABG) and 

the Community Mental Health Services Block Grant (MHBG). These block grants give states 1

maximum flexibility to address the M/SUD needs of their populations. The MHBG and SABG

differ in a number of their practices (e.g., targeted populations) and statutory authorities (e.g., 

method of calculating maintenance of effort (MOE), stakeholder input requirements for 

planning, set-asides for specific populations or programs, etc.2

). As a result, information on the 

services and clients supported by block grant funds varies by block grant and by state. 

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

ensure the nation’s M/SUD system provides access to high quality and cost-effective treatment 

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

program quality and outcomes should be carefully tracked so that data can inform 

improvements. 

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

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

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

the Republic of Palau.

2 In addition to statutory authority, SABG is detailed by comprehensive regulation. http://www.samhsa.gov/grants/blockgrants/laws-regulations
2

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

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

redesigned the FFY 2012-2013 MHBG and SABG applications to better align with the current 

federal/state environments and related policy initiatives, including the Mental Health Parity and 

Addiction Equity Act (MHPAEA) and the Tribal Law and Order Act (TLOA). 

The FFY 2022-2023 Block Grant Application furthers SAMHSA’s efforts to have states use and 

report the opportunities offered under various federal initiatives. The FFY 2022-2023 Block 

Grant Application allows states to submit a combined application for both MHBG and SABG 

funds and requires a biennial plan for the MHBG while allowing a biennial plan for the 

SABG. This Application also reflects the health care system’s strong emphasis on coordinated 

and integrated care along with the need to improve services for persons with mental health and 

substance use disorders. In addition, questions about identified needs allow SAMHSA to better 

design technical assistance to support state efforts.

In accordance with the Consolidated Appropriations Act, 2021 [P.L. 116-260], SAMHSA 

received supplemental appropriations in the sum of $3.3 billion ($1.65 billion each) to the 

Mental Health and Substance Abuse Block Grants to combat behavioral health impacts of the 

COVID-19 pandemic across the nation. This additional funding will affect how states pay for 

and provide services as along with who will be the recipients of said services. The COVID-19 

funding maintains that states must appropriate no less than 20 percent of their allotment for 

primary prevention services, however, allows for waiver on other programmatic requirements of 

the block grant. States were given some leeway as to allowable activities so long as they could 

attribute them to M/SUD. New planning and reporting requirements are required to account for 

these additional funds and allowable activities. The expenditure period for this funding is March 

15, 2021 to March 14, 2023. 

Further supplemental appropriations were provided through the American Rescue Plan Act 

(ARP), 2021 [P.L. 117-2] in the sum of $3 billion ($1.5 billion each) to the block grants. 

SAMHSA, through guidance received regarding this funding, asks states to improve and enhance 

their mental health and substance use service array. To address the issue of healthcare equity, 

states must address treatment and recovery needs of people in rural areas and underserved 

populations through this round of supplemental funding. States are encouraged to base these 

new services on the mental health and substance abuse issues exacerbated by the COVID-19 

pandemic and heightened by social inequities present in the healthcare system. An additional 

requirement for this funding was preparation for a potential set aside for recovery-based services. 

The timeline for funding planning and expenditure is from September 1, 2021 to September 30, 

2025, which necessitates changes to several years of block grant planning and reporting 

requirements. 

B. Impact on State Authorities and Systems

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

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

addressing these factors, SMHAs and SSAs will enhance their ability to increase access to 

evidence-based services. 
3

The block grant authorizing legislation and implementing regulations prohibit the provision of 

financial assistance to any entity other than a public or nonprofit entity and require that the 

funding be used only for authorized activities.3

 SAMHSA Guidance on the use of block grant 

funding for co-pays, deductibles (including high deductible health plans), and premiums can be 

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

to develop specific policies and procedures for ensuring compliance with this guidance. 

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

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

state and federal sources available to purchase services. States should assist providers in the 

development of better financial strategies that will allow providers to be less dependent on 

SMHA and SSA funding only. Funding available from the Centers for Medicare & Medicaid 

Services (CMS), such as CHIP, Medicaid, and Medicare may play an important role in the 

states’ financial strategy. There are also national demonstration projects and programs (e.g., 

Health Homes, Clinical Practice Transformation, Innovation Accelerator Program, State 

Innovation Models, Comprehensive Community Behavioral Health Centers, and Financial

Alignment Initiative for Medicare-Medicaid Enrollees) that support efforts to provide M/SUD

services. In addition, M/SUD services supported through the Health Resources and Services 

Administration (HRSA) must be considered as states develop these strategies. For example, 

HRSA has significantly expanded access to health and M/SUD services through its Health 

Center Program. HRSA has also made available funding and other opportunities to increase

and enhance the quality of the M/SUD workforce (e.g., National Health Service Corps, training 

grants, etc.). Both TRICARE and the Department of Veterans’ Affairs (VA) have enhanced 

their M/SUD services as well. This means that SMHAs and SSAs (as well as public health 

authorities responsible for prevention) will need to engage and collaborate with these partners at 

the federal, state and community levels. Persons eligible for such services should be assisted in 

accessing these services as appropriate.

States should focus on vulnerable and underserved populations. 

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

evolving needs that may be addressed. These populations include military families, youth who 

need M/SUD services, individuals who experience trauma, people with co-occurring addictions 

(including opioid use disorder) and disabilities (including intellectual and developmental 

disabilities), increased numbers of individuals diverted or released from correctional facilities, 

diverse racial and ethnic minority groups, American Indians and Alaska Natives, Older Adults, 

and LGBTQ+ individuals. 

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

a manner that promotes recovery and resiliency. Individuals who have lived experiences with 

M/SUD are playing an increasingly important role in the delivery of recovery-oriented services. 

Services should require the availability of culturally specific content for racial and ethnic 

3 http://www.samhsa.gov/grants/block-grants/laws-regulations
4

minorities. Services should address the unique needs of tribal populations and the role of tribal 

governments in planning and delivering care.

The use of appropriate technologies may support better access to services. Technology has 

changed significantly since SAMHSA’s inception in 1992. Technology plays an increasing role 

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

Communication Technologies (ICT) are being used more frequently to deliver various health 

care and recovery support services by providers and to report health information and outcomes 

by individuals. 

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

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

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

health data.

All SAMHSA grantees that provide services to individuals are encouraged to demonstrate 

ongoing clinical use of a EHR system. A certified EHR is a system that has been tested and 

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

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

certifications required for interoperable health information technology as issued by the ONC.4

 

In addition to meeting common standards and certification, these systems should support the 

privacy and security of patient information across all HIT technologies. Such systems should 

be used to collect information on provider characteristics, client enrollment, demographics, and 

treatment. Current laws require these systems to comply with national standards such as 

national provider numbers, International Classification of Diseases (ICD-10), Systematized 

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

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

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

information technology systems will also have to be interoperable with providers across the 

continuum of care, as well as health information exchanges (HIE), health information 

organizations (HIOs), and payers (e.g., Medicaid, Medicare, and private insurance plans, etc.). 

SAMHSA believes it is important for public health purchasers to continue to collaborate and

discuss system interoperability, electronic health records, federal information technology 

requirements, and other related matters. Additional information can be found at SAMHSA 

https://www.samhsa.gov/section-223/certification-resource-guides/health-informationtechnology and ONC https://www.healthit.gov/ . 

4 Office of the National Coordinator for Health Information Technology (ONC) is at the forefront of the administration’s health 

IT efforts and is a resource to the entire health system to support the adoption of health information technology and the 

promotion of nationwide, standards-based health information exchange to improve health care. ONC is organizationally located 

within the Office of the Secretary for the U.S. Department of Health and Human Services (HHS).
5

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

efficient service systems.

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

and enforcing MHPAEA and delivery of health system improvement in their states. In many 

respects, successful implementation depends on leadership and collaboration among multiple

stakeholders. The relationships among the SMHAs, SSAs, and the state Medicaid directors, 

insurance commissioners, prevention agencies, child-serving agencies, education authorities, 

justice authorities, public health authorities, and HIT authorities are integral to the effective and 

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

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

credentialing, consumer protection, and workforce development.

State authorities focus their system goals on recovery.

People can and do recover from M/SUD and services and supports must foster this recovery. 

Recovery benefits both the individual with an M/SUD condition and the community, leading to a 

healthier and more productive population. SAMHSA is committed to assisting states, providers, 

and people with M/SUD, families, and others in promoting recovery. 

SAMHSA recognizes the importance of recovery support services in the journey of individuals 

with SUD. Currently there is no requirement to fund recovery services with block grant dollars. 

Due to this lack of requirement there are only 140 communities that have recovery related 

organizations across the country. In the FY 2022 Presidential Budget, recovery support services 

are emphasized as an integral part of the continuum of care. Accordingly, SAMHSA believes 

that adding a 10 percent set aside for recovery support services will serve to promote recovery 

initiatives across the nation. This required set aside for recovery services would provide a 

dedicated and sustainable source for the recovery services community. Changes to both the 

budget forms and reporting requirements will be necessary to address this proposed new set aside 

requirement. 

State authorities continue to monitor the coverage of M/SUD services offered by Qualified 

Health Plans (QHPs) and Medicaid to ensure individuals with M/SUD conditions have adequate 

coverage and access to services. 

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

Organizations (ASO) to oversee and provide M/SUD services. State legislatures, state-based

marketplace entities, and state insurance commissioners have developed policies and regulations 

related to Electronic Handbooks. SMHAs and SSAs should be involved in these efforts to 

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

included in networks. 

States should 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 
6

analyze epidemiological data on substance use and its associated consequences. The system 

must also be able to use this data to identify areas of greatest need, and to identify, implement, 

and evaluate evidence-based programs, practices, and policies that have the ability to reduce 

substance use and improve health and well-being in all communities.

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

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

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

prevention providers will need to be able to collect data and report this information to the state. 

With limited resources, states should also look for opportunities to leverage different streams of 

funding to create a coordinated data-driven primary substance use disorder prevention system. 

Specifically, SAMHSA recommends that states align the 20 percent set-aside for primary 

prevention of the SABG with other federal, state, and local funding that will aid the state in 

developing and maintaining a comprehensive primary substance use disorder prevention system, 

as well as collaborate with and assure that behavioral health is part of the state’s larger public 

health prevention activities.

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

and purchasing decisions.

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

M/SUD services as critical input for making purchasing decisions and influencing coverage 

offered in their state through commercial insurers and Medicaid. In addition, states may also be 

able to use this information to educate policymakers and to justify their budget requests or other 

strategic planning efforts. States may also want to consider undertaking a similar process within 

their state to review local programs and practices that expand treatment technologies and show 

promising outcomes. 

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

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

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

through the block grant as well as discretionary and formula grantees. 

States authorities ensure that individuals with M/SUD conditions are receiving the mandated 

coverage and access in accordance with the federal parity law.

Plans and issuers subject to MHPAEA5 that offer M/SUD coverage as part of the overall health 

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

relation to medical/surgical benefits. Parity requires that the plans that offer M/SUD benefits do 

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

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

5 S.4388 - Mental Health Equity Act of 2020. (2020, July 30). Retrieved July 22, 2021, from

https://www.congress.gov/bill/116th-congress/senate-bill/4388/text?r=1&s=1 
7

components of the essential health benefits package required by the Affordable Care Act. 

Whether it is federal or state-level parity, continued efforts for education are instrumental in

increasing awareness of the benefits of mental health and addiction services and open the door to 

appropriate services, especially for potential first-time users. Some states have taken steps to 

enforce parity and are building on lessons learned. This active involvement to increase

awareness helps to ensure that consumers receive quality M/SUD prevention, treatment, and 

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

state should their claim be denied inappropriately by insurance companies.

State authorities are key players in M/SUD integration activities.

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

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

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

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

SMHAs and SSAs are in the best position to offer their Medicaid partners information regarding 

the most effective care coordination models, connect current providers that have effective

models, and assist with training or retraining staff to provide care coordination across prevention, 

treatment, and recovery activities. 

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

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

their integration efforts. The collaborations will be critical among M/SUD entities and 

comprehensive primary care provider organizations, such as maternal and child health clinics, 

community health centers, Ryan White HIV/AIDS CARE Act providers, and rural health

organizations. SMHAs and SSAs can assist SMAs with identifying principles, safeguards, and 

enhancements that will ensure that this integration supports key recovery principles and activities 

such as person-centered planning and self-direction. Specialty, emergency and rehabilitative 

care services, and systems addressing chronic health conditions such as diabetes or heart disease, 

long-term or post-acute care, and hospital emergency department care will see numerous M/SUD

issues among the persons served. SMHAs and SSAs should be collaborating to educate, consult, 

and serve patients, practitioners, and families seen in these systems. The full integration of 

community prevention activities is equally important. Other public health issues are impacted by 

M/SUD issues and vice versa. States should assure that the M/SUD system is actively engaged 

in these public health efforts. 

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

individuals with behavioral health conditions. States should strongly consider implementing

strategies for reducing smoking, including moving towards tobacco-free M/SUD facilities and 

grounds, and screening, referring, and/or treating tobacco use.

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

improving M/SUD prevention, treatment, and recovery for diverse populations with the goal of 

reducing disparities.

States are increasingly recognizing the value in addressing health disparities, realizing that failure 
8

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

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

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

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

progress in improving health equity6. Few of these plans, however, have focused specifically on 

M/SUD services. SSAs and SMHAs need to better track access, service use, and outcomes for 

these subpopulations to develop targeted outreach, engagement, enrollment, and intervention 

strategies to reduce such disparities.

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

adolescents’ M/SUD services.

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

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

sustaining this approach at the local level requires a parallel effort at the state level. As states 

adopt a system of care approach, they should address state policies that can support local 

efforts, identifying financing mechanisms, and enabling a family and youth input to policy at 

the state level. In addition to identifying the resources needed for services, states will need to 

develop a realistic planning process for enabling systems of care that includes the necessary 

staff time and administrative resources.

C. Block Grant Programs’ Purposes

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

activities and services to address the complex needs of individuals, families, and communities 

affected by substance use disorders and for adults with SMI and children with SED. The 

purpose of the block grant programs is to support these service needs. 

In order to assure that the block grant program continues to support the necessary services for 

the target population, SAMHSA has indicated that the block grants may be used:

1. To fund priority treatment and support services for individuals who are uninsured or 

underinsured. 

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

prevention activities. 

3. To collect performance and outcome data for mental health and substance use, determine

the effectiveness of promotion/SUD primary prevention, and treatment and recovery 

supports. 

II. SUBMISSION OF APPLICATION AND PLAN TIMEFRAMES

Statutory Deadlines 

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

6 http://www.samhsa.gov/behavioral-health-equity
9

encourages states to turn in their Application as early as possible to allow for a full discussion 

and review by SAMHSA. Applications for the MHBG are due no later than September 1, 2021. 

Applications for SABG are due no later than October 1, 2021. Single Applications for MHBG 

and SABG are due no later than September 1, 2021. MHBG and SABG Reports are due 

December 1, 2021. In addition, for the SABG, the Annual Synar Report is due no later than 

December 31, 2021. 

The FFY 2022-2023 MHBG and SABG Application(s) include(s) a two-year Mental and 

Substance Use Disorder Systems Assessment and Plan (Plan) as well as projected expenditure 

tables, certifications, and assurances. The Plan will cover a two-year period aligning with states’

FY budget cycle for SFY 2022-2023. States will have the option, but will not be required to 

amend their Plans when they submit their FFY 2023 Application. 

States should submit their respective MHBG and SABG Application(s) for FFYs 2022 and 

2023 based on the guidance provided in this document. The Plan provides a consistent 

framework for SMHAs and SSAs to assess the strengths and needs of their systems and to plan 

for system improvement, which is consistent with the strategic planning framework currently 

used by SAMHSA for various grants. The unique statutory and regulatory requirements of the 

specific block grants are described in the State Plan section. 

The FFY 2022-2023 Plan seeks to collect information from states regarding their activities in 

response to federal laws, initiatives, changes in technology, and advances in research and 

knowledge. The FFY 2022-2023 Plan has sections that are required and other sections where 

additional information is requested, but not required. The requested information is necessary for 

a full understanding of the design of the state system of care and provides a benefit to both the 

states and SAMHSA. There will be no penalty assessed to states that provide only information 

that is required. 

Required Sections and Tables

The FFY 2022-2023 Application requires states to submit a M/SUD assessment and plan; 

expenditure, performance, and utilization reports; executive summary; and funding agreements, 

assurances, and certifications. States are strongly encouraged to respond to each section so that

SAMHSA understands the totality of states’ efforts and how the block grant funding fits into 

the states’ overall goals and constraints. Section III.B, Planning Steps, requires states to 

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

steps: (1) assess the strengths and needs of the service system; (2) identify unmet service needs 

and critical gaps; (3) prioritize state planning activities to include the required target populations 

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

objectives, strategies, and performance indicators. Section III.B, Plan Table 1 (Priority Area 

and Annual Performance Indicators) and Plan Table 2 (State Agency Planned Expenditure) and 

Plan Table 6 (Non-Direct Services/System Development Activities Planned Expenditures) are 

required for both MHBG and SABG. For the SABG, Plan Table 3 (SABG Persons in 

need/receipt of treatment), Table 5a (SABG Primary Prevention Planned Expenditures) and 

Table 5b (SABG Planned Primary Prevention Targeted Priorities) are also required. 
10

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

technology advancements in physical and M/SUD prevention, treatment, and recovery. 

MHBG statute requires a description of the state’s comprehensive system of care for 

individuals with SMI and SED (42 U.S.C. §300x–1 (b) (1) (A)7

) and MHBG funds must be 

used for allowable activities based on MHBG statute. This information will help SAMHSA

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

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

models and assist other states with areas of common concern. 

Application Requirements and Award

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

Substance Use, to make an award under the programs involved, states must submit an 

application(s) sufficient to meet the requirements described in SAMHSA’s block grant 

authorizing legislation and implementing regulations sufficient for SAMHSA to monitor the 

states’ compliance efforts regarding the obligation and expenditure of MHBG and SABG funds. 

The funds awarded will be available for obligation and expenditure8 to plan, carry out, and 

evaluate activities and services for children with SED and adults with SMI; primary substance 

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

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

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

9, 10

 in the proper 

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

with each funding agreement for a grant under section 1911 of Title XIX, Part B, Subpart I of 

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

Act (42 U.S.C. § 300x-21) that is applicable to a state. The State Plan must include a 

description of the manner in which the state intends to obligate the grant funds, and it must 

include a report11 in the proper format containing information that the Secretary determines to 

be necessary for securing a record and description of the purposes for which both the MHBG 

and SABG were expended. States have the option of updating their plans during the two-year 

planning cycle. 

MHBG statute requires states to provide services to those with SMI and SED as described in 

the state’s plan only through appropriate, qualified community programs (which may include 

community mental health centers, child mental-health programs, psychosocial rehabilitation 

programs, mental health peer-support programs, and mental health primary consumer-directed 

programs) and community mental health centers which meet the criteria as described in 

7 State plan for comprehensive community mental health services for certain individuals, Subchapter XVII—Block Grants

U.S.C. § 42 U.S. Code § 300x–1 (Oct. 17, 2020). https://www.law.cornell.edu/uscode/text/42/300x-1 8 Title XIX, Part B of the PHS Act, http://www.samhsa.gov/grants/block-grants/laws-regulations 9 Section 1912 of Title XIX, Part B, Subpart I of the PHS Act (42 U.S.C. § 300x-2), http://www.samhsa.gov/grants/blockgrants/laws-regulations 10Section 1932(b) of Title XIX, Part B, Subpart II of the PHS Act (42 U.S.C. § 300x-32(b)), 

http://www.samhsa.gov/grants/block-grants/laws-regulations 11 Section 1942(a) of Title XIX, Part B, Subpart III of the PHS Act (42 U.S.C. § 300x-52(a)), 

http://www.samhsa.gov/grants/block-grants/laws-regulations
11

42 USC §300x-2 (c). 

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

submitting separate MHBG and SABG plans, it should clarify which system is being described 

in this section (e.g., mental health, substance misuse prevention, SUD treatment, or recovery). 

III. MENTAL AND SUBSTANCE USE DISORDER ASSESSMENT AND PLAN

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

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

identifying needs and gaps, states can prioritize and establish tailored goals, objectives, 

strategies, and performance indicators. In addition, the planning process should provide 

information on how the state will specifically spend available block grant funds consistent with 

the statutory and regulatory requirements, environment, and priorities described in this 

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

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

process and input of the Planning Council required by section 1914(b) of the PHS Act (42 

U.S.C. § 300x-4(b)) for the MHBG must be included in the application that addresses MHBG 

funds. States are also encouraged to expand this Planning Council to include prevention and 

SUD stakeholders and use this mechanism to assist in the development of the state plan for the 

SABG application. States must also describe the stakeholder input process for the development 

of both the SABG plan and the MHBG plan, as mandated by section 1941 of the PHS Act (42 

U.S.C.§ 300x-5112), which requires that the state plans be made available to the public in such a 

manner as to facilitate public comment during the development of the plan (including any 

revisions) and after the submission of the plan to the Secretary through SAMHSA. This 

description should also show involvement of persons who are service recipients and/or in 

recovery, families of individuals with M/SUD, providers of services and supports, 

representatives from racial and ethnic minorities, sexual and gender minority populations, 

persons with co-existing disabilities, and other key stakeholders. Evidence of meaningful 

consultation with federally recognized tribes where tribal governments or lands are located 

within the boundaries of the state are strongly encouraged for both MHBG and SABG. 

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

Treatment

States should identify and analyze the strengths, needs, and priorities of their M/SUD system. 

The strengths, needs, and priorities should consider specific populations that are the current 

focus of the block grants and the changing health care environment. 

12 Title XIX, Subpart III, section 1941 of the PHS Act (42 U.S.C. § 300x-51) requires, as a condition of the funding agreement 

for the grant, states will provide an opportunity for the public to comment on the state block grant plan. States should make the 

plan public in such a manner as to facilitate comment from any person (including federal, tribal, or other public agencies) both 

during the development of the plan (including any revisions) and after the submission of the plan to SAMHSA.
12

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

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

SAMHSA has clarified the definitions of SED and SMI. States may have additional elements 

that are included in their specific definitions, but the following provides a common baseline 

definition. Children with SED refers to persons from birth to age 18 and adults with SMI refers 

to persons age 18 and over; who (1) currently meet or at any time during the past year has met 

criteria for a mental disorder – including within developmental and cultural contexts – as 

specified within a recognized diagnostic classification system (e.g., most recent editions of 

DSM, ICD, etc.), and (2) display functional impairment, as determined by a standardized 

measure that impedes progress towards recovery and substantially interferes with or limits the 

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

activities.

Section 1912(b) of the Public Health Act (42 USC § 300x-1) establishes five criteria that must 

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

criteria are defined below: 

• Criterion 1: Comprehensive Community-Based Mental Health Service Systems:

Provides for the establishment and implementation of an organized community-based 

system of care for individuals with mental illness, including those with co-occurring 

M/SUD. States must have available services and resources within a comprehensive 

system of care, provided with federal, state, and other public and private resources, in 

order to enable such individuals to function outside of inpatient or residential 

institutions to the maximum extent of their capabilities. 

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

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

and have quantitative targets to be achieved in the implementation of the system of 

care described under Criterion 1. 

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

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

into a comprehensive system of care include social services; educational services, 

including services provided under IDEA; juvenile justice services; substance abuse 

services; and health and mental health services.

• Criterion 4: Targeted Services to Rural and Homeless Populations and to Older 

Adults: Provides outreach to and services for individuals who experience 

homelessness; community-based services to individuals in rural areas; and 

community-based services to older adults. 

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

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

training of providers of emergency health services regarding SMI and SED; and how 

the state intends to expend this grant for the fiscal years involved. 
13

States must submit a plan on how they will utilize the 10 percent set-aside funding in the MHBG 

to support appropriate evidence-based programs for individuals with Early Serious Mental 

Illness (ESMI) including psychosis. If a state chooses to submit a plan to utilize the set-aside for 

evidence-based services other than the services/principles components of Coordinated Specialty 

Care (CSC) approach developed via the Recovery After an Initial Schizophrenia Episode 

(RAISE) initiative, SAMHSA will review the plan with the state to assure that the approach 

proposed meets the understanding of an evidence-based approach. In consultation with National 

Institute of Mental Health (NIMH), as needed, either the proposals will be accepted or requests 

for modifications to the plan will be discussed and negotiated with the state. This initiative also 

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

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

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

primary substance use disorder prevention or preventive intervention for those at risk of SMI or 

SED. 

The Consolidated Appropriations Act, 2021 and the Coronavirus Response and Relief 

Supplement Appropriations Act, 2021 [P.L. 116-260] requires states to set-aside not less than 5 

percent of their total MHBG allocation amount for each fiscal year to support evidence-based 

crisis care programs addressing the needs of individuals with SMI and children with serious 

mental and emotional disturbances. The set-aside must be used to fund some or all of a set of 

core crisis care elements including: centrally deployed 24/7 mobile crisis units, short-term 

residential crisis stabilization beds, evidence-based protocols for delivering services to 

individuals with suicide risk, and regional or state-wide crisis call centers coordinating in real 

time.

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

recovery services, (and certain related activities) to at-risk individuals or persons in need of SUD 

treatment. See 42 U.S.C. §§ 300x-300x-66. 

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

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

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

must be addressed in the State Plan. 

• Criterion 1: Statewide Plan for Primary Substance Use Disorder Prevention, Treatment 

and Recovery Services for Individuals, Families and Communities (42 U.S.C. § 300x-21

and 45 CFR § 96.122) 

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

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

primary substance use disorder prevention programs, defined as programs for individuals 

who do not require treatment for substance use disorders. States must utilize this setaside to implement the six strategies and to carry out Section 1926 –Tobacco activities. 

States may also utilize funds for non-direct services.
14

• Criterion 3: Pregnant Women and Women with Dependent Children (42 U.S.C. § 300x22(b); 42 U.S.C. § 300x-27; 45 CFR § 96.124(c)(e); and 45 CFR § 96.131). The 

authorizing legislation and implementing regulation established a 5 percent set-aside that 

was applicable to the FFY 1993 and FFY 1992 SABG Notices of Award. For FFY 1994 

and subsequent fiscal years, states have been required to comply with a performance 

requirement that the states are required to obligate and expend funds for SUD treatment 

services designed for such women in an amount equal to the amount expended in FFY

1994. 

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

The authorizing legislation and implementing regulation established two performance 

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

funds to serve persons who inject drugs must comply with the requirement to admit an 

individual requesting admission to treatment within 14 days and not later than 120 days; 

and (2) outreach to encourage persons who inject drugs to seek SUD treatment 

Additionally, subject to the annual appropriation process, states may authorize such 

programs to obligate and expend SABG funds for elements of a syringe services 

program (SSP) pursuant to guidance developed by the HHS Office of HIV/AIDS an 

Infectious Disease Policy (OHIDP) . 

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

authorizing legislation and implementing regulation require any programs that receive 

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

entities, routinely make available tuberculosis services to each individual receiving SUD 

treatment services. 

• Criterion 6: Early Intervention Services Regarding the Human Immunodeficiency Virus 

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

implementing regulation require designated states to set-aside five percent of the SABG 

to establish 1 or more projects to provide EIS/HIV at the site(s) at which individuals are 

receiving SUD treatment services. 

• Criterion 7: Group Homes for Persons in Recovery from Substance Use Disorders (42 

U.S.C. § 300x-25 and 45 CFR § 96.129). The authorizing legislation and implementing 

regulation provide states with the flexibility to establish and maintain a revolving loan 

fund for the purpose of making loans, not to exceed $4,000, to a group of not more than 

six individuals to establish a recovery residence. 

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

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

96.132(c). The authorizing legislation and implementing regulation require states to 

promote the use of standardized screening and assessment instruments and placement 

criteria to improve patient retention and treatment outcomes. 

• Criterion 9: Independent Peer Review (42 U.S.C. § 300x-58(a) (1) (A) and 45 CFR § 
15

96.136). The authorizing legislation and implementing regulation require states to assess 

the quality, appropriateness, and efficacy of M/SUD treatment services. 

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

96.132(b). The authorizing legislation and implementing regulation requires any 

programs that receive SABG funds to ensure that prevention, treatment and recovery 

personnel operating in the state’s SUD system have an opportunity to receive training on 

an ongoing basis concerning recent trends in substance use in the state, improved 

methods and evidence-based practices for providing primary substance use disorder 

prevention and treatment services, performance-based accountability, data collection and 

reporting requirements, and any other matters that would serve to further improves the 

delivery of primary substance use disorder prevention and treatment services within the 

state. 

MHBG Children’s Set Aside: Verification of Minimum Spending Level 

States are required to provide services for children with SED. Each year the state shall expend 

not less than the amount expended in FY 1994. If there is a shortfall in funding available for 

children’s mental health services, the state may request a waiver. A waiver may be granted if 

the Secretary determines that the state is providing an adequate level of comprehensive 

community mental health services for children with SED, as indicated by comparing the 

number of children in need of such services with the services actually available within the 

state. 

MHBG Maintenance of Effort (MOE)

States are required to submit sufficient information for the Secretary to make a determination 

of compliance with the statutory maintenance of effort (MOE) requirements.13 MOE 

information is necessary to document that the state has maintained expenditures for 

community mental health services at a level that is not less than the average level of such 

expenditures maintained by the state for the 2-year period preceding the fiscal year for which 

the state is applying for the grant. The state shall only include community mental health 

services expenditures for individuals that meet the federal or state definition of SMI adults and 

SED children. States that received approval to exclude funds from the MOE calculation 

should include the appropriate MOE approval documents. 

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

grant. 

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

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

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

13 Title XIX, Part B, Subpart II, of the Public Health Service Act, as amended by the Children’s Health Act of 2000

(P.L.106-310) Title 42 U.S.C. § 42 U.S. Code § 300x–4 (Oct. 17, 2020). 
16

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

SMI and children with SED:

• Children with SED and their families*

• Adults with SMI* 

• Older Adults with SMI* 

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

• Individuals who have ESMI (10 percent MHBG set aside); 

• Individuals in need of behavioral health crisis services (5 percent MHBG set aside)

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

substance use disorder: 

• Persons who inject drugs* 

• Adolescents with substance use and/or mental health problems. 

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

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

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

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

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

• American Indians/Alaska Natives

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

• Individuals with tuberculosis* and other communicable diseases

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

persons living with HIV/AIDS who need mental health or substance use early 

intervention, treatment, or prevention services*14

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

Implementation Plan 15

• Prevention of HIV among persons who inject drugs; substance use is associated 

with a greater likelihood of acquiring HIV infection. HIV screening and other 

comprehensive HIV prevention services should be coupled with SUD treatment 

programs 

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

14 For the purpose of determining the states and jurisdictions which are considered “designated states” as described in section 

1924(b)(2) of Title XIX, Part B, Subpart II of the Public Health Service Act (42 U.S.C. § 300x-24(b)(2)) and section45 CFR § 

96.128(b) of the Substance Abuse Prevention and Treatment Block Grant; Interim Final Rule (45 CFR 96.120-137),). SAMHSA 

relies on the HIV Surveillance Report produced by the CDC, National Center for HIV/AIDS, Hepatitis, STD, and TB Prevention. 

The HIV Surveillance Report, Volume 25, will be used to determine the states and jurisdictions that will be required to set-aside 

5 percent of their respective FY 2016 SABG allotments to establish one or more projects to provide early intervention services 

for HIV at the sites at which individuals are receiving SUD treatment services. In FY 2012, SAMHSA developed and 

disseminated a policy change applicable to the EIS/HIV, which provided any state that was a “designated state” in any of the 3 

years prior to the year for which a state is applying for SABG funds with the flexibility to obligate and expend SABG funds for 

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

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

would be allowed to obligate and expend FY 2016 SABG funds for EIS/HIV if they chose to do so.

15 https://www.hiv.gov/federal-response/national-hiv-aids-strategy/nhas-update
17

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

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

• Individuals with M/SUD who experience homelessness or are involved in the 

criminal or juvenile justice systems

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

• Underserved racial and ethnic minority and LGBTQ++ populations 

• Persons with disabilities 

• Community populations for environmental prevention activities, including policy 

changing activities, and behavior change activities to change community, school, 

family, and business norms through laws, policy and guidelines and enforcement 

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

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

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

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

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

and related issues in their planning efforts. To the extent that such data are available in a 

state’s Olmstead Plan, it should be used for block grant planning purposes.

B. Planning Steps

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

below: 

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

specific populations.

Provide an overview of the state’s M/SUD prevention (description of the current prevention 

system’s attention to individuals in need of primary substance use disorder prevention), early 

identification, treatment, and recovery support systems, including the statutory criteria that 

must be addressed in the state’s Application. Describe how the public M/SUD system is 

currently organized at the state and local levels, differentiating between child and adult 

systems. This description should include a discussion of the roles of the SMHA, the SSA, and 

other state agencies with respect to the delivery of M/SUD services. States should also include 

a description of regional, county, tribal, and local entities that provide M/SUD services or 

contribute resources that assist in providing the services. In general, the overview should 

reflect the 11 SABG criteria detailed in “Environmental Factors and Plan” section.

Further, in support of the Executive Order On Advancing Racial Equity and Support for 

Underserved Communities Through the Federal Government, SAMHSA is committed to 

advancing equity for all, including people of color and others who have been historically 

underserved, marginalized, and adversely affected by persistent poverty and inequality. 

Therefore, the description should also include how these systems address the needs of diverse

racial and ethnic minorities (i.e., people of color and indigenous and Native American person, 

Asian Americans, and Pacific Islanders), members of religious minorities, lesbian, gay, bisexual, 

transgender, and queer (LGBTQ++) persons; persons with disabilities; persons who live in rural 
18

areas; and persons otherwise adversely affected by persistent poverty or inequality. Examples of 

system strengths might include long-standing interagency relationships, coordinated planning, 

training systems, and an active network of prevention coalitions. The lack of such strengths 

might be considered needs of the system, which should be discussed under Step 2. This narrative 

must include a discussion of the current service system’s attention to the SABG priority 

populations: Pregnant Women, Person Who Inject Drugs, Women with Dependent Children, 

Persons at Risk for Tuberculosis, Individuals in Need of Primary Substance Use Disorder 

Prevention, and, for FY 2022 HIV-designated states or a state designated in any of the prior three 

FY and opted to use SABG funds for early intervention services for HIV (EIS/HIV), Persons at 

Risk for HIV. See Appendix A for a list of the FY 2022 HIV-designated states.

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

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

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

relevant to each block grant within the state’s behavioral health system, especially for those 

required populations described in this document and other populations identified by the state as a

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

gaps. The state’s priorities and goals must be supported by data-driven processes. This could 

include data that is available through a number of different sources such as SAMHSA’s National

Survey on Drug Use and Health (NSDUH), Treatment Episode Data Set (TEDS), National 

Survey of Substance Abuse Treatment Services (N-SSATS), the Behavioral Health Barometer, 

Behavioral Risk Factor Surveillance System (BRFSS) , Youth Risk Behavior Surveillance 

System (YRBSS), the Uniform Reporting System (URS) and state data. Those states that have a 

State Epidemiological and Outcomes Workgroup (SEOW) should describe its composition and 

contribution to the process for primary prevention and treatment planning. States with current 

Partnership for Success discretionary grants are required to have an active SEOW. 

This narrative must include a discussion of the unmet service needs and critical gaps in the 

current system regarding the SABG priority populations: Pregnant Women, Person Who Inject 

Drugs, Women with Dependent Children, Persons at Risk for Tuberculosis, Individuals in Need 

of Primary Substance Use Disorder Prevention, and, for HIV-designated states, Persons at Risk 

for HIV. Moreover, a discussion of the unmet service needs and critical gaps in the current 

system regarding diverse racial and ethnic minorities (i.e., people of color and indigenous and 

Native American person, Asian Americans, and Pacific Islanders), members of religious 

minorities, lesbian, gay, bisexual, transgender, and queer (LGBTQ++) persons; persons with 

disabilities; persons who live in rural areas; and persons otherwise adversely affected by 

persistent poverty or inequality must be included. 

Step 3: Prioritize state planning activities

Prioritize state planning activities that will include MHBG and SABG. The priorities must 

include the core federal block grant goals and aims of the MHBG and SABG programs, as well 

as state programs with a focus on target populations (those required in legislation and regulation 

for each block grant) and other priority populations described in the document. States should list 

priorities in Plan Table 1 and indicate the priority type: substance use prevention (SAP), 
19

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

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

For each of the priorities, states should identify the relevant goals, measurable objectives, and at 

least one-performance indicator for each objective for the next two years. For each objective, 

the state should describe the specific strategy that will be used to achieve the objective. 

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

address the needs of specific populations, substance use and mental health treatment, substance 

use prevention activities, and system improvements that will address the objective. 

Strategies to consider and address include: 

• Strategies that are targeted for children and youth with SED or SUD. States should use a 

system of care approach that has been well established for children with SED and cooccurring SUD. This approach should be used statewide, coordinating care with other 

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

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

competent, individualized treatment plan. For adolescents with SUD and SED, this 

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

use or dependence. 

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

connect with, or provide the best possible treatment, and design and implement 

recovery-oriented services.

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

housing models that integrate individuals into the community instead of long-term care 

facilities or nursing homes and other settings that fail to promote independence and 

inclusion. This also can include strategies to promote competitive and evidenced-based 

supported employment in the community, rather than segregated programs.

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

be used to engage individuals and their families into prevention, treatment, and recovery 

supports. Almost 40 percent of uninsured individuals are under the age of 30 and use 

technology as a substantial, if not primary, mode of communication. 

• Strategies that result in developing recovery support services (e.g., peer support 

services, recovery housing, permanent housing and supportive employment or 

education for persons with M/SUD). This includes how local authorities will be

engaged to increase the availability of housing, employment, and educational 

opportunities, and how the state will develop services that will wrap around these

individuals to obtain and maintain safe and affordable housing, employment, and/or 

education. 
20

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

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

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

ethnic and racial minorities and LGBTQ+ populations. States will be encouraged to refer 

to the IOM reports, Race, Ethnicity, and Language Data: Standardization for Health 

Care Quality Improvement 16 and The Health of Lesbian, Gay, Bisexual, and Transgender 

People: Building a Foundation for Better Understanding17 in developing this strategy. 

• Strategies that will build the state and provider capacity to provide evidence-based, traumaspecific interventions in the context of a trauma-informed delivery system. Recognizing 

trauma as a critical factor in the development of M/SUD, states should build provider 

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

treatments are provided in systems that understand the impact of trauma on their service 

population and work to eliminate organizational practices and policies that may cause new 

or exacerbate existing trauma. SAMHSA has developed “SAMHSA’s Concept of Trauma 

and Guidance for a Trauma-Informed Approach” to provide states with a framework for 

incorporation of trauma informed care into its system. 

• Strategies that increase the use of person-centered planning, self-direction, and participantdirected care. This includes measures to help individuals or caregivers (when appropriate) 

identify and access services and supports that reinforce recovery or resilience. These 

strategies should also include how individuals or caregivers have access to supports to 

facilitate participant direction, including the ability to manage a flexible budget to address 

recovery goals; identifying, selecting hiring and managing support workers and providers; and 

ability to purchase goods and services identified in the recovery or resilience planning process.

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

policies and practices in their prevention efforts that include funding all six prevention 

strategies that are listed below: 

• Information dissemination. 

• Education. 

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

• Problem identification and referral to education. 

• Community based programming; and, 

• Environmental strategies that establish or change written and unwritten community 

standards, codes, and attitudes, thereby influencing incidence and prevalence of the 

abuse of alcohol, tobacco, and other drugs used in the general population. 

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

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

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

Board on Healthcare Services. Cheryl Ulmer, Bernadette McFadden, and David R. Nerenz, Editors, Washington, DC: 

The National Academies Press 17 IOM (Institute of Medicine). 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for 

Better Understanding. Washington, DC: The National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK64806/ 
21

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

Prevent and Reduce Underage Drinking18, Evidence Based Practices Resource Center

and/or other materials documenting their effectiveness. For the education prevention 

strategy, evidence based repositories may be used to find appropriate programs that align 

with statutory requirements of the SABG and the parameters of the specific populations 

that are being served (e.g. Blueprints for Healthy Youth Development). 

These strategies include:

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

supported by research and encompass a range of activities including policy initiatives 

and programs. 

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

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

ways to address the problems, and enhance resiliency. 

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

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

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

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

Underage Drinking, and Facing Addiction in America: The Surgeon General’s Report 

on Alcohol, Drugs and Health which focus on policy and environmental programming

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

alcohol use; and offer the latest science and research on prevention, treatment and 

recovery.

• Strategies that address harder-to-reach racial/ethnic minority and sexual and gender 

minority communities that experience a cluster of risk factors that make them 

especially vulnerable to substance use and related problems.

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

substance use. 

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

identified in the needs assessment. System improvement activities should: 

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

adaptation of EHRs, or to develop strategies to increase workforce numbers. These

system improvement activities should use federal and state resources currently available 

and those proposed for the planning period to enhance the competency of the M/SUD

workforce. System improvements that seek to expand the workforce should build upon 

existing efforts to increase M/SUD skill development in a wide range of professions as 

well as increase the role of people in recovery from M/SUD in the planning and delivery 

of services.

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

care or administrative service organizations (including accountable care organizations 

(ACOs)). This may include assistance to develop the necessary infrastructure (e.g., 

electronic billing and EHRs) and reporting requirements to participate in these

18 https://www.ncbi.nlm.nih.gov/books/NBK44360/
22

networks. 

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

recovery support services, which are already delivered by volunteers and paid 

staff. Peers are trained, supervised, and regarded as staff and operate out of a 

community-based or recovery organization. A state’s strategy should allow states 

to support peer and other recovery support services delivered under either model. 

The infrastructure, including paid staff, to coordinate and encourage the use of 

volunteer-delivered or run services should also be supported. 

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

M/SUD providers working with M/SUD provider organizations for expertise, 

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

screen patients for M/SUD. Activities should also focus on developing model contract 

templates for reciprocal health and M/SUD integration and identifying state policies that 

present barriers to reimbursement. This would include efforts to implement dual 

eligible products, ACOs, and medical homes.

• Develop support systems to provide communities with necessary needs assessment 

information, planning, technical assistance, evaluation expertise, and other resources to 

foster the development of comprehensive community plans to improve mental, 

emotional, and M/SUD outcomes.

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

M/SUD services and language assistance services for people who experience 

communication barriers to access.

• Develop benefit management strategies for high-cost services (e.g., youth out of home 

services and adult residential services). SAMHSA believes that states should align 

their care management to guarantee that individuals get the right service at the right 

time in the right amount. These efforts should ensure that decisions made regarding 

these services are clinically sound. 

Planning Tables 

States should describe specific performance indicators that will be used to determine if the

goals for that priority area were achieved. For each performance indicator, the state must 

describe the data and data source that has been used to develop the baseline for FFY 2022 and 

how the state proposes to measure the change in FFY 2023. States must use the template

(Plan Table 1: Priority Areas by Goal, Strategy, and Performance Indicators) below. As a 

reminder, these population performance indicators should reflect the unmet need listed in 

Planning Step 2 and discussed above under Step 3 and Step 4. 

Plan Table #1. Priority Area and Annual Performance Indicators 

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

Health and Primary Substance Use Disorder Prevention and Treatment Planning Steps to 

complete Plan Table 1. States are to complete a separate table for each state priority area to be 

included in the MHBG and SABG. Please include the following information when entering 

into WebBGAS: 
23

1. Priority area (based on an unmet service need or critical gap: After this information 

is completed for the first priority area, another table will appear so additional 

priorities can be added. 

2. Priority type: From the drop-down menu, select SAP – primary substance use 

disorder prevention, SAT – substance use disorder treatment, or MHS -- mental 

health service.

3. Targeted/required populations: Indicate the population(s) required in statute for 

each block grant as well as those populations encouraged, as described in IIIA 

Framework for Planning—Mental Health and Substance Abuse Prevention and 

Treatment. States must include at least one priority for each required population. 

For example, at least one priority and indicator must be denoted SAP and PP. From 

the drop-down menu select:

a) SMI–Adults with SMI, 

b) SED–Children with an SED, 

c) ESMI--Individuals with ESMI including psychosis, 

d) PWWDC–Pregnant women and women with dependent children, 

e) PP–persons in need of primary substance use disorder prevention, 

f) PWID–Persons who inject drugs (formerly known as intravenous drug users 

(IVDU)), 

g) EIS/HIV–Persons with or at risk of HIV/AIDS who are receiving SUD treatment 

services, 

a) TB–Persons with or at risk of tuberculosis who are receiving SUD treatment 

services, and/or 

4. Other- Specify (Refer to section IIIA of the Assessment and Plan).

Goal of the priority area. Goal is a broad statement of general intention. Therefore, 

provide a general description of what the state hopes to accomplish. 

5. Objective: Objective should be a concrete, precise, and measurable statement.

6. Strategies to attain the objective. Indicate program strategies or means to achieve the 

stated objective. 

7. Annual Performance Indicators to measure success on a yearly basis. Each indicator 

must reflect progress on a measure that is impacted by the block grant. After indicator is

completed with the information for the first indicator below, the table will expand to enter 

additional indicators. For each performance indicator, specify the following components:

a) Baseline measurement from where the state assesses progress; 

b) First-year target/outcome measurement (Progress to the end of SFY 2022); 

c) Second-year target/outcome measurement (Final to the end of SFY 2023);

d) Data source; 

e) Description of data; and 

f) Data issues/caveats that affect outcome measures.
24

Plan Table 1: Priority Area and Annual Performance Indicators

1. Priority Area:

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

3. Population(s) (SMI, SED, ESMI, PWWDC, PP, PWID, EIS/HIV, TB, OTHER): 

4. Goal of the priority area: 

5. Objective:

6. Strategies to attain the objective: 

7. Annual Performance Indicators to measure achievement of the objective:

Indicator #1: 

Plan Table 1: Priority Area and Annual Performance Indicators, continued

a) Baseline measurement (Initial data collected prior to and during SFY 2022): 

b) First-year target/outcome measurement (Progress to the end of SFY 2022):

c) Second-year target/outcome measurement (Final to the end of SFY 2023):

d) Data source: 

e) Description of data:

f) Data issues/caveats that affect outcome measures:

SAMHSA will work with states to monitor whether they are meeting the goals, objectives and 

performance indicators established in their plans, and to provide technical assistance as 

needed. SAMHSA staff will work with states during the year to discuss progress, identify 

barriers, and develop solutions to address these barriers.

If a state is unable to achieve its goals and objectives as stated in its application(s) approved 

by SAMHSA, the state will be asked to provide a description of corrective actions to be 

taken. If further steps are not taken, SAMHSA may ask the state for a revised plan, which 

SAMHSA will assist in developing, to achieve its goals and objectives. States that do not 

choose to apply for the MHBG or SABG will have their funds redirected to other states as 

provided in statute.19

19 http://www.samhsa.gov/grants/block-grants/laws-regulations
25

Plan Table 2: State Agency Planned Expenditures MHBG

Table 2 addresses funds to be expended during the 24-month period of July 1, 2021 through June 30, 2023. Table 2 now includes 

columns to capture state expenditures for COVID-19 Relief Supplemental and ARP Supplemental funds. Please use these columns to 

capture how much the state plans to expend over a 24-month period (7/1/21-6/30/23). Please document the use of COVID-19 Relief 

Supplemental and ARP Supplemental funds in the footnotes.

*Please note that MHBG and SABG now have two separate Table 2 submissions. 

MHBG: Include public mental health services provided by mental health providers or funded by the state mental health agency by source of funding *)

Planning Period- From: To:

ACTIVITY

(See instructions for using Row 1.)

A. 

Substance 

Abuse Block 

Grant 

B. Mental 

Health Block 

Grant

C. Medicaid 

(Federal, 

State, 

and local)

D. Other Federal 

Funds (e.g., ACF 

(TANF), CDC, 

CMS (Medicare)

SAMHSA, etc.)

E. State 

funds

F. Local funds 

(excluding local

Medicaid)

G. Other H. COVID-19 

Relief Funds

(MHBG)a 

I. COVID-19 

Relief Funds 

(SABG)

J. ARP Funds 

(MHBG)b

1. Substance Abuse Prevention and 

Treatment 

a. Pregnant Women and Women with 

Dependent Children

b. All Other

2. Primary Prevention

a. Substance Abuse Primary

Prevention

b. Mental Health Primary

prevention e 

3. Evidence-Based Practices for Early 

Serious Mental Illness including First 

Episode Psychosis (10 percent of total

award MHBG) d 

4. Tuberculosis Services

5. Early Intervention Services for HIV

6. State Hospital

7. Other 24-Hour Care

ACTIVITY

(See instructions for using Row 1.)

A. 

Substance B. Mental 

C. Medicaid 

(Federal, 

D. Other Federal 

Funds (e.g., ACF 

E. State 

funds

F. Local funds 

(excluding local

G. Other H. COVID-19 

Relief Funds

I. COVID-19 

Relief Funds 

J. ARP Funds 

(MHBG)b
26

Abuse Block 

Grant

Health Block 

Grant

State, 

and local)

(TANF), CDC, 

CMS (Medicare)

SAMHSA, etc.)

Medicaid) (MHBG)a (SABG)

8. Ambulatory/Community Non-24 

Hour Care

9. Administration (excluding program / 

provider level) MHBG and SABG must 

be reported separately

10. Crisis Services (5% set-aside) f 

13. Total $ $ $ $ $ $ $ $ $ $ 

a The 24-month expenditure period for the COVID-19 Relief supplemental funding is March 15, 2021 – March 14, 2023, which is different from the 

expenditure period for the “standard” MHBG. Per the instructions, the standard MHBG expenditures captured in Columns A – G are for the state planned 

expenditure period of July 1, 2022 – June 30, 2024, for most states.

b The expenditure period for The American Rescue Plan Act of 2021 (ARP) supplemental funding is September 1, 2021 – September 1, 2025, which is 

different from the expenditure period for the “standard” MHBG. Per the instructions, the standard MHBG expenditures captured in Columns A – G are for 

the state planned expenditure period of July 1, 2022 – June 30, 2024, for most states.” c While the state may use state or other funding for these services, the MHBG funds must be directed toward adults with SMI or children with SED

d Column 3B should include Early Serious Mental Illness programs funded through MHBG set aside

e Per statute, Administrative expenditures cannot exceed 5 percent of the fiscal year award. f Row 10 should include Crisis Services programs funded through different funding sources, including the MHBG set aside. States may expend more than 5 

percent of their MHBG allocation.
27

Plan Table 2: State Agency Planned Expenditures SABG

ONLY include funds expended by the executive branch agency administering the SABG

ACTIVITY

(See instructions for using 

Row 1.)

A. Substance 

Abuse Block 

Grant

B. 

Mental 

Health 

Block 

Grant

C. Medicaid

(Federal, 

State, and 

local)

D. Other 

Federal 

Funds (e.g., 

ACF (TANF), 

CDC, CMS 

(Medicare) 

SAMHSA, 

etc.) 

E. State 

funds

F. Local 

funds

(excluding 

local

Medicaid)

G. Other H. COVID-19-

19 Relief 

Funds 

(MHBG) a 

I.COVID-19-19 

Relief Funds 

(SABG) a 

J. ARP Funds 

(SABG)b 

1. Substance Abuse 

Prevention and 

Treatment 

$ $ $ $ $ $ $ $ 

a. Pregnant Women 

and Women with 

Dependent Children*

b. All Other 

2. Primary Prevention $ $ $ $ $ $ $ $ 

a. Substance Abuse 

Primary Prevention

b. Mental Health Primary 

Prevention

3. Evidence-Based Practices 

for Early Serious Mental 

Illness including First 

Episode Psychosis (10 

percent of total award 

MHBG)f

4. Tuberculosis Services

5. Early Intervention 

Services for HIV

6. State Hospital

ACTIVITY A. Substance 

Abuse Block 

B. 

Mental 

C. Medicaid

(Federal, 

D. Other 

Federal Funds 

E. State 

funds

F. Local 

funds

G. Other H. COVID-19 

Relief Funds 

I.COVID-19 

Relief Funds 

J. ARP Funds 

(SABG)b
28

a. The 24-month expenditure period for the COVID-19 Relief supplemental funding is March 15, 2021 – March 14, 2023, which is different from the 

expenditure period for the “standard” MHBG/SABG. Per the instructions, the standard MHBG/SABG expenditures captured in Columns A – G are for the state 

planned expenditure period of July 1, 2020 – June 30, 2021, for most states. 

b. The expenditure period for The American Rescue Plan Act of 2021 (ARP) supplemental funding is September 1, 2021 – September 30, 2025, which is 

different from the expenditure period for the “standard” MHBG/SABG. Per the instructions, the planning period for standard MHBG/SABG expenditures is July 1, 

2021 – June 30, 2023.

c. Prevention other than primary prevention

d. The 20 percent set-aside funds in the SABG must be used for activities designed to prevent substance misuse.

e. While the state may use state or other funding for these services, the MHBG funds must be directed toward adults with SMI or children with SED 

f. Column 3B should include Early Serious Mental Illness programs funded through MHBG set-aside. Per statute, administrative expenditures cannot exceed 

5 percent of the fiscal year award. 

g. Row 10 should include Crisis Services programs funded through different funding sources, including the MHBG set aside. States may expend more than 5 

percent of their MHBG allocation. 

(See instructions for 

using Row 1.)

Grant Health 

Block 

Grant

State, and 

local)

(e.g., ACF 

(TANF), CDC, 

CMS 

(Medicare) 

SAMHSA, 

etc.)

(excluding 

local

Medicaid)

(MHBG) a (SABG) a

7. Other 24-Hour Care

8. Ambulatory/Community 

Non-24 Hour Care

9. Administration 

(excluding program / 

provider level) MHBG 

and SABG must be 

reported separately g

10. Crisis Services (5 percent 

set-aside)h 

12. Total $ $ $ $ $ $ $ $ $ $ 
29

Plan Table 3: SABG Persons in need/receipt of SUD treatment

To complete the Aggregate Number Estimated in Need column, please refer to the most recent edition of SAMHSA’s National Survey 

on Drug Use and Health (NSDUH) or other federal/state data that describes the populations of focus in rows 1-5. 

To complete the Aggregate Number in Treatment column, please refer to the most recent edition of the Treatment Episode Data Set 

(TEDS) data prepared and submitted to SAMHSA’s Behavioral Health Services Information System (BHSIS) contractors, Hendall Inc. 

Plan Table 3 SABG Persons in need/receipt of SUD treatment

State Identifier: 

Aggregate number estimated in need Aggregate number in treatment

1. Pregnant Women

2. Women with Dependent Children

3. Individuals with a co-occurring M/SUD 

4. Persons who inject drugs

5. Persons experiencing homelessness

Please provide an explanation for any data cells for which the state does not have a data source. 
30

Plan Table 4: SABG Planned Expenditures. 

States must project how they will use SABG funds to provide authorized services as required by the SABG regulations, including the 

supplemental COVID-19 and ARP funds. Plan Table 4 must be completed for the FFY 2022 and FFY 2023 SABG awards. The totals 

for each Fiscal Year should match the President’s Budget Allotment for the state.

Plan Table 4 SABG Planned Expenditures

State Identifier: 

Expenditure Category FFY 2022 SABG

Award

COVID-19 Award 1 ARP Award 2 FFY 2023 SABG

Award

COVID-19 Award 1 ARP Award 2 

1. Substance Use Disorder 

Prevention3 and Treatment

$ $ $ $ $ $ 

2. Primary Substance Use 

Disorder Prevention

$ $ $ $ $ $ 

3. Early Intervention Services for 

HIV4

$ $ $ $ $ $ 

4. Tuberculosis Services

$ $ $ $ $ $ 

5. Administration (SSA level only)

$ $ $ $ $ $ 

6. Total $ $ $ $ $ $ 

1. The 24-month expenditure period for the COVID-19 Relief Supplemental funding is March 15, 2021 - March 14, 2023. Per the instructions, the planning 

period for the standard SABG expenditures for the FFY 2021 SABG Award is October 1, 2020 - September 30, 2021. For purposes of this table, all COVID-19

Relief Supplemental expenditures between March 15, 2021 and September 30, 2021 should be entered in this column.

2. The expenditure period for The American Rescue Plan Act of 2021 (ARP) supplemental funding is September 1, 2021 - September 30, 2025, which is 

different from the expenditure period for the FY 2021 "standard" SABG, which is October 1, 2020 - September 30, 2021. The planned expenditures for the period 

of September 1, 2021 - September 30, 2021 should be entered here.

3. Prevention other than Primary Prevention

4. For the purpose of determining which states and jurisdictions are considered “designated states” as described in section 1924(b)(2) of Title XIX, Part B, 

Subpart II of the Public Health Service Act (42 U.S.C. § 300x-24(b)(2)) and section 45 CFR § 96.128(b) of the Substance Abuse Prevention and Treatment Block 

Grant (SABG); Interim Final Rule (45 CFR 96.120-137), SAMHSA relies on the HIV Surveillance Report produced by the Centers for Disease Control and 
31

Prevention (CDC,), National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. The most recent HIV Surveillance Report published on or before 

October 1 of the federal fiscal year for which a state is applying for a grant is used to determine the states and jurisdictions that will be required to set-aside 5 

percent of their respective SABG allotments to establish one or more projects to provide early intervention services regarding the human immunodeficiency virus 

(EIS/HIV) at the sites at which individuals are receiving SUD treatment services. In FY 2012, SAMHSA developed and disseminated a policy change applicable to 

the EIS/HIV which provided any state that was a “designated state” in any of the three years prior to the year for which a state is applying for SABG funds with the 

flexibility to obligate and expend SABG funds for EIS/HIV even though the state’s AIDS case rate does not meet the AIDS case rate threshold for the fiscal year 

involved for which a state is applying for SABG funds. Therefore, any state with an AIDS case rate below 10 or more such cases per 100,000 that meets the criteria 

described in the 2012 policy guidance will be allowed to obligate and expend SABG funds for EIS/HIV if they chose to do so.
32

Plan Table 5a: Primary Prevention Planned Expenditures 

States must spend no less than 20 percent of their SABG allotment on substance use 

disorder primary prevention strategies. The state must spend the majority of the funds 

implementing the six substance use disorder primary prevention strategies. These strategies 

are directed at individuals not identified to need treatment. To report on their primary 

prevention planned expenditures, states must complete Table 5a. 

Table 5a SABG Primary Prevention Planned Expenditures by Strategy and IOM 

Category 

The state’s primary prevention program must include, but is not limited to, the six primary 

prevention strategies defined below. On Table 5a, states should list their FFY 2022 and 

FFY 2023 SABG planned expenditures for each of the six primary prevention strategies. 

Expenditures within each of the six strategies should be directly associated with the cost of 

completing the activity or task; for example, information dissemination should include the 

cost of developing pamphlets, the time of participating staff or the cost of public service 

announcements, etc. If a state plans to use strategies not covered by these six categories or 

the state is unable to calculate expenditures by strategy, please report them under “Other” in 

Table 5a. 

In most cases, the total SABG amount should equal the amount reported on Plan Table 4, 

Row 2, Primary Substance Use Disorder Prevention. The one exception is if the state 

chooses to use a portion of the primary prevention set-aside to fund Non-Direct 

Services/System Development activities. The total on Table 6 prevention column combined 

with the total on Table 5a should equal to expenditure Table 4, Row 2 in most instances. 

Primary Prevention Planned Expenditures by IOM Category 

Information Dissemination– This strategy provides knowledge and increases awareness of the nature 

and extent of alcohol and other drug use, abuse, and addiction, as well as their effects on individuals, 

families, and communities. It also provides knowledge and increases awareness of available prevention 

and treatment programs and services. It is characterized by one-way communication from the source to 

the audience, with limited contact between the two.

Education - This strategy builds skills through structured learning processes. Critical life and social 

skills include decision making, peer resistance, coping with stress, problem solving, interpersonal 

communication, and systematic and judgmental abilities. There is more interaction between facilitators 

and participants than in the information strategy. 

Alternatives - This strategy provides participation in activities that exclude alcohol and other drugs. 

The purpose is to meet the needs filled by alcohol and other drugs with healthy activities and to 

discourage the use of alcohol and drugs through these activities. 

Problem Identification and Referral to Education - This strategy aims at identification of those who 

have indulged in illegal/age-inappropriate use of tobacco or alcohol and those individuals who have 

indulged in the first use of illicit drugs in order to assess if their behavior can be reversed through 

education. It should be noted, however, that this strategy does not include any activity designed to 

determine if a person needs treatment.
33

Community-based Process - This strategy provides ongoing networking activities and technical 

assistance to community groups or agencies. It encompasses neighborhood-based, grassroots 

empowerment models using action planning and collaborative systems planning. 

Environmental - This strategy establishes, or changes written and unwritten community standards, 

codes, and attitudes; thereby, influencing alcohol and other drug use by the general population. 

Other - States that plan their primary prevention expenditures using the IOM model of universal, 

selective, and indicated should use Table 5a to list their FFY 2022 and FFY 2023 SABG planned 

expenditures in each of these categories. 

Institute of Medicine Classification: Universal, Selective, and Indicated: 

Prevention strategies may be classified using the IOM Model of Universal, Selective, and Indicated, 

which classifies preventive interventions by the population targeted. Definitions for these categories 

appear below:

Universal: Activities targeted to the public or a whole population group that have not been identified 

based on individual risk. 

Universal Direct. Row 1 - Interventions directly serve an identifiable group of participants but who 

have not been identified on the basis of individual risk (e.g., school curriculum, after-school program, 

parenting class). This also could include interventions involving interpersonal and ongoing/repeated 

contact (e.g., coalitions). 

Universal Indirect. Row 2 - Interventions support population-based programs and environmental 

strategies (e.g., establishing ATOD policies, modifying ATOD advertising practices). This also could 

include interventions involving programs and policies implemented by coalitions. 

Selective: Activities targeted to individuals or a subgroup of the population whose risk of developing a 

disorder is significantly higher than average. 

Indicated: Activities targeted to individuals in high-risk environments, identified as having minimal but 

detectable signs or symptoms foreshadowing disorder or having biological markers indicating 

predisposition for disorder but not meeting diagnostic levels (Adapted from The Institute of Medicine). 

States that are able to report on both the strategy type and the population served (universal, selective, or 

indicated) should do so. If planned expenditure information is only available by strategy type, then the 

state should report planned expenditures in the row titled Unspecified (for example, Information 

Dissemination Unspecified). 

Section 1926 - Tobacco: Costs Associated with the Synar Program. Per January 19, 1996, 45 CFR Part 

96 Tobacco Regulation for Substance Abuse Prevention and Treatment Block Grants; Final Rule (45 

CFR § 96.130), states may not use the Block Grant to fund the enforcement of their statute, except that 

they may expend funds from their primary prevention set aside of their block grant allotment under 45 

CFR § 96.124(b)(1) for carrying out the administrative aspects of the requirements such as the 

development of the sample design and the conducting of the inspections. 
34

Public Law 116-94, signed on December 20, 2019, supersedes this legislation, and increased 

the minimum age for tobacco sales from 18 to 21. SAMHSA revised its guidance to clarify 

that the prevention set-aside may be used to fund revisions to states’ Synar program to 

comply with PL 116-94. These funds should be reported in the appropriate columns. 

Plan Table 5a: SABG Primary Prevention Planned Expenditures

State Identifier:

Report Period- From: To:

A B C 

Strategy IOM Target FFY 2022 FFY 2023 

SABG COVID-19 1 ARP 2 SABG COVID-19 1 ARP 2 

1. Information 

Dissemination

Universal $ $ 

Selected $ $ 

Indicated $ $ 

Unspecified $ $ 

Total

2. Education Universal $ $ 

Selected $ $ 

Indicated $ $ 

Unspecified $ $ 

Total

3. Alternatives Universal $ $ 

Selected $ $ 

Indicated $ $ 

Unspecified $ $ 

Total

4. Problem Identification 

and Referral to 

Education

Universal $ $ 

Selected $ $ 

Indicated $ $ 

Unspecified $ $ 

Total

5. Community-Based 

Processes

Universal $ $ 

Selected $ $ 

Indicated $ $ 

Unspecified $ $ 

Total

6. Environmental Universal $ $ 

Selected $ $ 

Indicated $ $ 

Unspecified $ $ 

Total

7. Section 1926 (Synar)-

Tobacco

Universal $ $ 

Selected $ $ 

Indicated $ $ 

Unspecified $ $ 

Total
35

8. Other Universal

Direct

$ $ 

Universal 

Indirect

$ $ 

Selected $ $ 

Indicated $ $ 

Unspecified $ $ 

SABG COVID-19 1 ARP 2 SABG COVID-19 1ARP 2

Total

9. Total Prevention 

Expenditures

$ $ 

Total Award 3 $ $ 

Planned Primary 

Prevention

Percentage

% % 

1 The 24-month expenditure period for the COVID-19 Relief supplemental funding is March 15, 2021 – March 14, 2023, 

which is different from the expenditure period for the “standard” SABG. Per the instructions, the standard SABG 

expenditures are for the planned expenditure period of October 1, 2021 – September 30, 2023, for most states. 1 The expenditure period for The American Rescue Plan Act of 2021 (ARP) supplemental funding is September 1, 2021 – 

September 1, 2025, which is different from the expenditure period for the “standard” SABG. Per the instructions, the 

standard SABG expenditures are for the planned expenditure period of October 1, 2021 – September 30, 2023. 3 Total SABG Award is populated from Table 4 - SABG Planned Expenditures

Plan Table 5b: SABG Planned Primary Prevention Targeted Priorities (Required)

States should identify the categories of substances the state block grant plans to target with primary 

prevention set-aside dollars from the FFY 2022 and FFY 2023 SABG awards. 

Planning Period Start Date: 10/1/2021 Planning Period End Date: 9/30/2023

SABG Award COVID-19 Award1 ARP Award2

Targeted Substances

Alcohol

  

Tobacco

  

Marijuana

  

Prescription Drugs

  

Cocaine

  

Heroin

  

Inhalants

  
36

SABG Award COVID-19 Award1 ARP Award2

Methamphetamine

  

Targeted Populations

Students in College

  

Military Families

  

LGBTQ+

  

American Indians/Alaska

Natives

  

African American

  

Hispanic

  

Homeless

  

Native Hawaiian/Other

Pacific Islanders

  

Asian

  

Rural

  

Underserved Racial and 

Ethnic Minorities

  

OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022

1. The 24-month expenditure period for the COVID-19 Relief supplemental funding is March 15, 2021 – March 14, 2023, which is 

different from the expenditure period for the “standard” SABG. Per the instructions, the standard SABG expenditures are for 

the planned expenditure period of October 1, 2021 – September 30, 2023, for most states.

2. The expenditure period for The American Rescue Plan Act of 2021 (ARP) supplemental funding is September 1, 2021 – 

September 1, 2025, which is different from the expenditure period for the “standard” SABG. Per the instructions, the standard 

SABG expenditures are for the planned expenditure period of October 1, 2021 – September 30, 2023.

Footnotes:
37

Plan Table 6: Categories for Expenditures for System Development/Non-Direct-Service 

Activities

Please note there is a separate table for MHBG. Only complete this table if the state plans to 

fund expenditures for non-direct services/system development with MHBG, SABG, COVID-19, 

and/or ARP dollars. 

Expenditures for these activities may be direct expenditures (involving the time of state or substate personnel, or other state or sub-state resources) or be through funding mechanisms with 

independent organizations. Expenditures may come from the administrative funds and/or 

program funds (but may not include the HIV set-aside funds). These include state, regional, and 

local personnel salaries prorated for time spent and operating costs such as travel, printing, 

advertising, and conducting meetings related to the categories below. 

Non-direct services/system development activities exclude expenditures through funding 

mechanisms for providing treatment or mental health “direct service” and primary prevention 

efforts themselves. Instead, these expenditures provide support to those activities. 

Please utilize the following categories to describe the types of expenditures your state supports 

with BG funds. Although the states may use a different classification system, please use these 

categories to describe the types of expenditures your state supports with BG funds, when the 

preponderance of the activity fits within a category. 

Information systems – This includes collecting and analyzing treatment data as well as 

prevention data under the SABG in order to monitor performance and outcomes. Costs for 

EHRs and other health information technology also fall under this category. 

Infrastructure Support – This includes activities that provide the infrastructure to support 

services but for which there are no individual services delivered. Examples include the 

development and maintenance of a crisis-response capacity, including hotlines, mobile crisis 

teams, web-based check-in groups (for medication, treatment, and re-entry follow-up), drop-in 

centers, and respite services. 

Partnerships, community outreach, and needs assessment – This includes state, regional, and 

local personnel salaries prorated for time and materials to support planning meetings, 

information collection, analysis, and travel. It also includes the support for partnerships across 

state and local agencies, and tribal governments. Community/network development activities, 

such as marketing, communication, and public education, and including the planning and 

coordination of services, fall into this category, as do needs-assessment projects to identify the 

scope and magnitude of the problem, resources available, gaps in services, and strategies to 

close those gaps. 

Planning Council Activities – This includes those supports for the performance of a Mental 

Health Planning Council under the MHBG, a combined Behavioral Health Planning Council, or 

(OPTIONAL) Advisory Council for the SABG. 
38

Quality assurance and improvement - This includes activities to improve the overall quality of 

services, including those activities to assure conformity to acceptable professional standards, 

adaptation, and review of implementation of evidence-based practices, identification of areas of 

technical assistance related to quality outcomes, including feedback. Administrative agency 

contracts to monitor service-provider quality fall into this category, as do independent peerreview activities.

Research and evaluation - This includes performance measurement, evaluation, and research, 

such as services research and demonstration projects to test feasibility and effectiveness of a new 

approach as well as the dissemination of such information. 

Training and education - This includes skill development and continuing education for 

personnel employed in local programs as well as partnering agencies, as long as the training 

relates to either SUD service delivery (prevention, treatment and recovery) for SABG and 

services to adults with SMI or children with SED for MHBG. Typical costs include course fees, 

tuition, and expense reimbursements to employees, trainer(s) and support staff salaries, and 

certification expenditures. 
39

Plan Table 6: Categories for Expenditures for System Development/Non-Direct-Service Activities MHBG

Please enter the total amount of the MHBG, COVID-19, or ARP funds expended for each activity. 

Non-Direct-Services/System Development

MHBG Table 6 

MHBG Planning Period- From: To:

Activity A. FFY 2022 

Block Grant

B. FFY 2022 

COVID-19

Funds1 

C. FFY 2022 

ARP Funds2 

D. FFY 2023 

Block Grant

E. FFY 2023 

COVID-19

Funds1 

F. FFY 2023 ARP 

funds2 

1. Information Systems

2. Infrastructure Support

3. Partnerships, community outreach, and

needs assessment

4. Planning Council Activities (MHBG required, 

SABG optional)

5. Quality Assurance and Improvement

6. Research and Evaluation

7. Training and Education

8. Total $ $ $ $ $ $ 

1

The 24-month expenditure period for the COVID-19 Relief supplemental funding is March 15, 2021 – March 14, 2023, which is different from the expenditure 

period for the “standard” MHBG. Per the instructions, the standard MHBG expenditures captured in Columns A – G are for the state planned expenditure period of 

July 1, 2022 – June 30, 2024, for most states. 2

The expenditure period for The American Rescue Plan Act of 2021 (ARP) supplemental funding is September 1, 2021 – September 1, 2025, which is different from 

the expenditure period for the “standard” MHBG. Per the instructions, the standard MHBG expenditures captured in Columns A – G are for the state planned 

expenditure period of July 1, 2022 – June 30, 2024, for most states.”
40

Plan Table 6: Categories for Expenditures for System Development/Non-Direct-Service Activities SABG

Please enter the total amount of the SABG, COVID-19, or ARP funds expended for each activity. 

SABG Table 6

Non-Direct-Services/System Development

FFY 2022 FFY 2023

Activity A. SABG 

Treatment 

B. SABG 

Prevention

C. SABG 

Integrated 1

D. COVID19 2 E. ARP 3 A. SABG 

Treatment

B. SABG 

Prevention

C. SABG 

Integrated 1 

D. COVID19 2 E. ARP 3 

1. Information 

Systems

2. Infrastructure 

Support

3. Partnerships, 

community 

outreach, and 

needs 

assessment

4. Planning 

Council 

Activities 

(MHBG 

required, 

SABG 

optional)

5. Quality 

assurance and 

improvement

6. Research and 

Evaluation

7. Training and 

Education
41

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

1

Integrated refers to non-direct service/system development expenditures that support both treatment and prevention systems of care. 2

The 24-month expenditure period for the COVID-19 Relief supplemental funding is March 15, 2021 - March 14, 2023, which is different from the expenditure period 

for the "standard" SABG and MHBG. Per the instructions, the standard SABG expenditures are for the state planned expenditure period of July 1, 2021 - June 30, 

2023, for most states. 

3

The expenditure period for The American Rescue Plan Act of 2021 (ARP) supplemental funding is September 1, 2021 - September 30, 2025, which is different from 

the expenditure period for the "standard" SABG. Per the instructions, the standard SABG expenditures are for the state planned expenditure period of July 1, 2021 - 

June 30, 2023. 
42

C. Environmental Factors and Plan 

1. Access to Care, Integration, and Care Coordination - Required

 Across the United States, significant percentages of adults with SMI, children and youth with 

SED, and people with SUD do not access needed behavioral health care. States should focus on 

improving the range and quality of available services and on improving the rate at which 

individuals who need care access it. States have a number of opportunities to improve access, 

including improving capacity to identify and address behavioral needs in primary care, outreach 

and screening in a variety of community settings, building behavioral health workforce and 

service system capacity, and efforts to improve public awareness around the importance of 

behavioral health. When considering access to care, states should examine whether people are 

connected to services and whether they are receiving the range of needed treatment and supports. 

For example, only 7.9 percent of adults with co-occurring M/SUD received treatment for both in 

2019.20

 A venue for states to advance access to care is addressing financing barriers by ensuring that 

parity protections are being adhered to in private and public sector health plans and that 

providers and people receiving services are aware of parity protections. SSAs and SMHAs can 

partner with their state departments of insurance and Medicaid agencies to support parity 

enforcement efforts and to boost awareness around parity protections within the behavioral 

health field.

The integration of primary and behavioral health care remains a priority across the country to 

ensure that people receive care that addresses their mental health, substance use, and physical 

health problems. People with M/SUD are likely to die earlier than those who do not have these 

conditions.21 Ensuring that people with M/SUD get access to physical and behavioral health 

care is important to address the physical health disparities they experience and to ensure that they 

receive needed behavioral health care. States should support integrated care delivery in specialty 

behavioral health care settings as well as primary care settings. States have a number of options 

to finance the integration or primary and behavioral health care, including programs supported 

through Medicaid managed care, Medicaid health homes, specialized plans for individuals who 

are dually eligible for Medicaid and Medicare, and targeted initiatives through the MHBG and 

SABG or general funds. States may also work to advance specific models shown to improve 

care in primary care settings, including Primary Care Medical Homes; the Coordinated Care 

Model; and Screening, Brief Intervention, and Referral to Treatment. 

 Navigating behavioral health, physical health, and other support systems is complicated and 

many individuals and families require care coordination to ensure that they receive necessary 

supports in and efficient and effective manner. States should develop systems that vary the 

20 Substance Abuse and Mental Health Services Administration. (2020). Key substance use and mental health indicators in the United States: 

Results from the 2019 National Survey on Drug Use and Health (HHS Publication No. PEP20-07-01-001, NSDUH Series H-55). Rockville, MD: 

Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved 

from https://www.samhsa.gov/data/ 21 Druss, B. G., Zhao, L., Von Esenwein, S., Morrato, E. H., & Marcus, S. C. (2011). Understanding excess mortality in persons with mental 

illness: 17-year follow up of a nationally representative US survey. Medical care, 599-604.Avaiable at: https://journals.lww.com/lwwmedicalcare/Fulltext/2011/06000/Understanding_Excess_Mortality_in_Persons_With.11.aspx
43

intensity of care coordination support based on the seriousness and complexity of individual 

need. States also need to consider different models of care coordination for different groups, 

such as High-Fidelity Wraparound and Systems of Care when working with children, youth, and 

families; providing Assertive Community Treatment to people with SMI who are at a high risk 

of institutional placement; and connecting people in recovery from SUD with a range of recovery

supports. States should also provide the care coordination necessary to connect people with 

M/SUD to needed supports in areas like education, employment, and housing. 

1. Describe your state’s efforts to improve access to care for mental disorders, substance use 

disorders, and co-occurring disorders, including detail on efforts to increase access to 

services for: 

a) Adults with SMI

b) Adults with SUD

c) Children and youth with SED or SUD 

d) Individuals with co-occurring M/SUD

2. Describe your efforts, alone or in partnership with your state’s department of insurance 

and/or Medicaid system to advance parity enforcement and increase awareness of parity 

protections among the public and across the behavioral and general health care fields. 

3. Describe how the state supports integrated behavioral health and primary health care, including 

services forindividuals with mental disorders, substance use disorders, and co-occurring 

mental and substance use disorders. Include detail about: 

a) Access to behavioral health care facilitated through primary care providers 

b) Efforts to improve behavioral health care provided by primary care providers 

c) Efforts to integrate primary care into behavioral health settings
44

4. Describe how the state provides care coordination, including detail about how care 

coordination is funded and how care coordination models provided by the state vary based on 

the seriousness and complexity of individual behavioral health needs. Describe care 

coordination available to: 

a) Adults with SMI

b) Adults with SUD

c) Children and youth with SED or SUD

5. Describe how the state supports the provision of integrated services and supports for 

individuals with co-occurring mental and substance use disorders, including screening and 

assessment for co-occurring disorders and integrated treatment that addresses substance use 

disorders as well as mental disorders. Please describe how this system differs for youth and 

adults. 

2. Health Disparities - Required

In accordance with the HHS Action Plan to Reduce Racial and Ethnic Health Disparities22, 

Healthy People, 202023, National Stakeholder Strategy for Achieving Health Equity24, and other

HHS and federal policy recommendations, SAMHSA expects block grant dollars to support 

equity in access, services provided, and M/SUD outcomes among individuals of all cultures, 

sexual/gender minorities, orientation and ethnicities. Accordingly, grantees should collect and 

use data to: (1) identify subpopulations (e.g., racial, ethnic, limited English speaking, tribal, 

sexual/gender minority groups, etc.) vulnerable to health disparities and (2) implement 

strategies to decrease the disparities in access, service use, and outcomes both within those 

subpopulations and in comparison to the general population. One strategy for addressing health 

disparities is use of the recently revised National Standards for Culturally and Linguistically 

22 http://www.minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf 23 http://www.healthypeople.gov/2020/default.aspx 24https://www.minorityhealth.hhs.gov/npa/files/Plans/NSS/NSS_07_Section3.pdf
45

Appropriate Services in Health and Health Care (CLAS).25

The Action Plan to Reduce Racial and Ethnic Health Disparities, which the HHS Secretary 

released in April 2011, outlines goals and actions that HHS agencies, including SAMHSA, will 

take to reduce health disparities among racial and ethnic minorities. Agencies are required to 

assess the impact of their policies and programs on health disparities.

The HHS Secretary’s top priority in the Action Plan is to “[a]ssess and heighten the impact of 

all HHS policies, programs, processes, and resource decisions to reduce health disparities. 

HHS leadership will assure that program grantees, as applicable, will be required to submit 

health disparity impact statements as part of their grant applications. Such statements can 

inform future HHS investments and policy goals, and in some instances, could be used to score 

grant applications if underlying program authority permits.”26 

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

promote equity. In October 2011, HHS issued final standards on the collection of race, 

ethnicity, primary language, and disability status.27 This guidance conforms to the existing

Office of Management and Budget (OMB) directive on racial/ethnic categories with the

expansion of intra-group, detailed data for the Latino and the Asian-American/Pacific Islander 

populations.28 In addition, SAMHSA and all other HHS agencies have updated their limited 

English proficiency plans and, accordingly, will expect block grant dollars to support a

reduction in disparities related to access, service use, and outcomes that are associated with 

limited English proficiency. These three departmental initiatives, along with SAMHSA’s and 

HHS’s attention to special service needs and disparities within tribal populations, LGBTQ+

populations, and women and girls, provide the foundation for addressing health disparities in 

the service delivery system. States provide M/SUD services to these individuals with state

block grant dollars. While the block grant generally requires the use of evidence-based and 

promising practices, it is important to note that many of these practices have not been normed 

on various diverse racial and ethnic populations. States should strive to implement evidencebased and promising practices in a manner that meets the needs of the populations they serve. 

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

populations of focus are subpopulations that may have disparate access to, use of, or outcomes 

from provided services. These disparities may be the result of differences in insurance coverage, 

language, beliefs, norms, values, and/or socioeconomic factors specific to that subpopulation. 

For instance, lack of Spanish primary care services may contribute to a heightened risk for 

metabolic disorders among Latino adults with SMI; and American Indian/Alaska Native youth 

may have an increased incidence of underage binge drinking due to coping patterns related to 

historical trauma within the American Indian/Alaska Native community. While these factors 

might not be pervasive among the general population served by the block grant, they may be 

predominant among subpopulations or groups vulnerable to disparities.

25 http://www.ThinkCulturalHealth.hhs.gov 26 http://www.minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf 27 https://aspe.hhs.gov/basic-report/hhs-implementation-guidance-data-collection-standards-race-ethnicity-sex-primarylanguage-and-disability-status 28 : https://www.whitehouse.gov/wp-content/uploads/2017/11/Revisions-to-the-Standards-for-the-Classification-ofFederal-Data-on-Race-and-Ethnicity-October30-1997.pdf
46

To address and ultimately reduce disparities, it is important for states to have a detailed 

understanding of who is and is not being served within the community, including in what 

languages, in order to implement appropriate outreach and engagement strategies for diverse

populations. The types of services provided, retention in services, and outcomes are critical 

measures of quality and outcomes of care for diverse groups. For states to address the

potentially disparate impact of their block grant funded efforts, they will address access, use, 

and outcomes for subpopulations. 

Please respond to the following items:

1) Does the state track access or enrollment in services, types of services received and outcomes 

of these services by: race, ethnicity, gender, sexual orientation, and age? 

a) race Yes No

b) ethnicity Yes No

c) gender Yes No

d) sexual orientation Yes No

e) gender identity Yes No

f) age Yes No

2) Does the state have a data-driven plan to address and reduce disparities in access, service use, 

and outcomes for the above subpopulation? 

Yes No

3) Does the state have a plan to identify, address, and monitor linguistic disparities/language 

barriers? 

Yes No

4) Does the state have a workforce-training plan to build the capacity of M/SUD providers to 

identify disparities in access, services received, and outcomes and provide support for 

improved culturally and linguistically competent outreach, engagement, prevention, 

treatment, and recovery services for diverse populations? 

Yes No

5) If yes, does this plan include the Culturally and Linguistically Appropriate Services (CLAS) 

Standards? 

Yes No

6) Does the state have a budget item allocated to identifying and remediating disparities in 

M/SUD care? 

Yes No

7) Does the state have any activities related to this section that you would like to highlight? 
47

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

 

3. Innovation in Purchasing Decisions - Requested

While there are different ways to define value-based purchasing, its purpose is to identify 

services, payment arrangements, incentives, and players that can be included in directed 

strategies using purchasing practices that are aimed at improving the value of health care 

services. In short, health care value is a function of both cost and quality: 

Health Care Value = Quality ÷ Cost, (V = Q ÷ C) 

SAMHSA anticipates that the movement toward value-based purchasing will continue as 

delivery system reforms continue to shape state systems. The identification and replication of 

such value-based strategies and structures will be important to the development of M/SUD

systems and services. 

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

delivery of medical and specialty care including M/SUD services. Over the past several years, 

SAMHSA has collaborated with CMS, HRSA, SMAs, state M/SUD authorities, legislators, 

and others regarding the evidence of various mental and substance misuse prevention, 

treatment, and recovery support services. States and other purchasers are requesting 

information on evidence-based practices or other procedures that result in better health 

outcomes for individuals and the general population. While the emphasis on evidence-based 

practices will continue, there is a need to develop and create new interventions and 

technologies and in turn, to establish the evidence. SAMHSA supports states’ use of the 

block grants for this purpose. The NQF and the IOM recommend that evidence play a critical 

role in designing health benefits for individuals enrolled in commercial insurance, Medicaid, 

and Medicare.

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

activities. SAMHSA’s Evidence Based Practices Resource Center assesses the research 

evaluating an intervention's impact on outcomes and provides information on available 

resources to facilitate the effective dissemination and implementation of the program. 

SAMHSA’s Evidence-Based Practices Resource Center provides the information & tools 

needed to incorporate evidence-based practices into communities or clinical settings.

SAMHSA reviewed and analyzed the current evidence for a wide range of interventions for 
48

individuals with M/SUD, including youth and adults with chronic addiction disorders, adults 

with SMI, and children and youth with SED. The evidence builds on the consensus standards 

that have been developed in many national reports over the last decade or more. These include 

reports by the Surgeon General,29 The New Freedom Commission on Mental Health,

30 the 

IOM,31 NQF, and the Interdepartmental Serious Mental Illness Coordinating Committee

(ISMICC).

32 The activity included a systematic assessment of the current research findings for 

the effectiveness of the services using a strict set of evidentiary standards. This series of 

assessments was published in “Psychiatry Online.”33 SAMHSA and other federal partners, the 

HHS’ Administration for Children and Families, Office for Civil Rights, and CMS, have used 

this information to sponsor technical expert panels that provide specific recommendations to the 

M/SUD field regarding what the evidence indicates works and for whom, to identify specific

strategies for embedding these practices in provider organizations, and to recommend additional 

service research. 

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

stages of development. Anecdotal evidence and program data indicate effectiveness for these 

services. As these practices continue to be evaluated, the evidence is collected to establish 

their efficacy and to advance the knowledge of the field. 

SAMHSA’s Treatment Improvement Protocol Series (TIPS)34 are best practice guidelines for 

SUD treatment. SAMHSA draws on the experience and knowledge of clinical, research, and 

administrative experts to produce the TIPS, which are distributed to a growing number of 

facilities and individuals across the country. The audience for the TIPS is expanding beyond 

public and private SUD treatment facilities as AOTD disorders are increasingly recognized as a

major health problem.

SAMHSA’s Evidence-Based Practice Knowledge Informing Transformation (KIT)35 was

developed to help move the latest information available on effective M/SUD practices into 

community-based service delivery. States, communities, administrators, practitioners, 

consumers of mental health care, and their family members can use KIT to design and 

implement M/SUD practices that work. KIT covers getting started, building the program, 

training frontline staff, and evaluating the program. The KITs contain information sheets, 

introductory videos, practice demonstration videos, and training manuals. Each KIT outlines 

the essential components of the evidence-based practice and provides suggestions collected 

from those who have successfully implemented them.

29 United States Public Health Service Office of the Surgeon General (1999). Mental Health: A Report of the Surgeon General. 

Rockville, MD: Department of Health and Human Services, U.S. Public Health Service 30 The President’s New Freedom Commission on Mental Health (July 2003). Achieving the Promise: Transforming Mental 

Health Care in America. Rockville, MD: Department of Health and Human Services, Substance Abuse and Mental Health

Services Administration. 31 Institute of Medicine Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders 

(2006). Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series. 

Washington, DC: National Academies Press. 32 National Quality Forum (2007). National Voluntary Consensus Standards for the Treatment of Substance Use 

Conditions: Evidence-Based Treatment Practices. Washington, DC: National Quality Forum. 33http://psychiatryonline.org/ 34 http://store.samhsa.gov 35 https://store.samhsa.gov/?f%5B0%5D=series%3A5558 
49

SAMHSA is interested in whether and how states are using evidence in their purchasing 

decisions, educating policymakers, or supporting providers to offer high quality services. In 

addition, SAMHSA is concerned with what additional information is needed by SMHAs and 

SSAs in their efforts to continue to shape their and other purchasers’ decisions regarding M/SUD

services. 

Please respond to the following items:

1. Is information used regarding evidence-based or promising practices in your purchasing or 

policy decisions? 

Yes No

2. Which value-based purchasing strategies do you use in your state? (check all that apply): 

a) Leadership support, including investment of human and financial resources. 

b) Use of available and credible data to identify better quality and monitored the impact 

of quality improvement interventions. 

c) Use of financial and non-financial incentives for providers or consumers. 

d) Provider involvement in planning value-based purchasing. 

e) Use of accurate and reliable measures of quality in payment arrangements.

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

g) Involvement in CMS or commercial insurance value-based purchasing programs 

(health homes, ACO, all payer/global payments, pay for performance (P4P)). 

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

3. Does the state have any activities related to this section that you would like to highlight? 

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

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

(ESMI)-10 percent set aside - Required for MHBG

Much of the mental health treatment and recovery service efforts are focused on the later stages 
50

of illness, intervening only when things have reached the level of a crisis. While this kind of 

treatment is critical, it is also costly in terms of increased financial burdens for public mental 

health systems, lost economic productivity, and the toll taken on individuals and families. There 

are growing concerns among consumers and family members that the mental health system 

needs to do more when people first experience these conditions to prevent long-term adverse 

consequences. Early intervention* is critical to treating mental illness before it can cause tragic 

results like serious impairment, unemployment, homelessness, poverty, and suicide. The 

duration of untreated mental illness, defined as the time interval between the onset of a mental 

disorder and when an individual gets into treatment, has been a predictor of outcomes across 

different mental illnesses. Evidence indicates that a prolonged duration of untreated mental 

illness may be viewed as a negative prognostic factor for those who are diagnosed with mental 

illness. Earlier treatment and interventions not only reduce acute symptoms but may also 

improve long-term prognosis. 

SAMHSA’s working definition of an Early Serious Mental Illness is “An early serious mental 

illness or ESMI is a condition that affects an individual regardless of their age and that is a 

diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic 

criteria specified within DSM-5 (APA, 2013). For a significant portion of the time since the 

onset of the disturbance, the individual has not achieved or is at risk for not achieving the 

expected level of interpersonal, academic, or occupational functioning. This definition is not 

intended to include conditions that are attributable to the physiologic effects of SUD, are 

attributable to an intellectual/developmental disorder or are attributable to another medical 

condition. The term ESMI is intended for the initial period of onset.” 

States may implement models that have demonstrated efficacy, including the range of services 

and principles identified by National Institute of Mental Health (NIMH) via its Recovery After 

an Initial Schizophrenia Episode (RAISE) initiative. Utilizing these principles, regardless of the 

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

Medicaid or private insurance, states should move their system to address the needs of 

individuals with a first episode of psychosis (FEP). RAISE was a set of NIMH sponsored 

studies beginning in 2008, focusing on the early identification and provision of evidence-based 

treatments to persons experiencing FEP. The NIMH RAISE studies, as well as similar early 

intervention programs tested worldwide, consist of multiple evidence-based treatment 

components used in tandem as part of a Coordinated Specialty Care (CSC) model, and have been 

shown to improve symptoms, reduce relapse, and lead to better outcomes. 

States shall expend not less than 10 percent of the MHBG amount the state receives for carrying 

out this section for each fiscal year to support evidence-based programs that address the needs of 

individuals with ESMI, including psychotic disorders, regardless of the age of the individual at 

onset. In lieu of expending 10 percent of the amount the state receives under this section for a 

fiscal year as required, a state may elect to expend not less than 20 percent of such amount by the 

end of the succeeding fiscal year.

* MHBG funds cannot be used for primary prevention activities. States cannot use MHBG funds 

for prodromal symptoms (specific group of symptoms that may precede the onset and diagnosis 

of a mental illness) and/or those who are not diagnosed with a SMI. 
51

1. Please name the model(s) that the state implemented including the number of programs for 

each model for those with ESMI using MHBG funds. 

Model(s)/EBP(s) for 

ESMI/FEP

Number of 

programs 

2. Please provide the total budget/planned expenditure for ESMI/FEP for FY 22 and FY 23 

(only include MHBG funds). 

FY2022 FY2023 

3. Please describe the status of billing Medicaid or other insurances for ESMI/FEP services. 

How are components of the model currently being billed? Please explain. 

4. Please provide a description of the programs that the state funds to implement evidencebased practices for those with ESMI/FEP.

5. Does the state monitor fidelity of the chosen EBP(s)? 

Yes No

6. Does the state provide trainings to increase capacity of providers to deliver interventions 

related to ESMI?

Yes No

7. Explain how programs increase access to essential services and improve client outcomes for 

those with an ESMI/FEP? 
52

8. Please describe the planned activities in FY2022 and FY2023 for your state’s ESMI 

programs. 

9. Please list the diagnostic categories identified for your state’s ESMI programs.

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

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

States must engage adults with SMI or children with SED and their caregivers where appropriate 

in making health care decisions, including activities that enhance communication among 

individuals, families, caregivers, and treatment providers. Person-centered planning (PCP) is a 

process through which individuals develop their plan of service. The PCP may include a 

representative who the person has freely chosen, and/or who is authorized to make personal or 

health decisions for the person. The PCP team may include family members, legal guardians, 

friends, caregivers, and others that the person or his/her representative wishes to include. The 

PCP should involve the person receiving services and supports to the maximum extent possible, 

even if the person has a legal representative. The PCP approach identifies the person’s strengths, 

goals, preferences, needs and desired outcome. The role of state and agency workers (for 

example, options counselors, support brokers, social workers, peer support workers, and others) 

in the PCP process is to enable and assist people to identify and access a unique mix of paid and 

unpaid services to meet their needs and provide support during planning. The person’s goals and 

preferences in areas such as recreation, transportation, friendships, therapies, home, employment, 
53

education, family relationships, and treatments are part of a written plan that is consistent with 

the person’s needs and desires. 

In addition to adopting PCP at the service level, for PCP to be fully implemented it is important 

for states to develop systems which incorporate the concepts throughout all levels of the mental 

health network. Resources for assessing and developing PCP systems can be found at the 

National Center on Advancing Person-Centered Practices and Systems 

https://ncapps.acl.gov/home.html with a systems assessment at 

https://ncapps.acl.gov/docs/NCAPPS_SelfAssessment_201030.pdf. 

1. Does your state have policies related to person centered planning? Yes No

2. If no, describe any action steps planned by the state in developing PCP initiatives in the 

future. 

3. Describe how the state engages consumers and their caregivers in making health care 

decisions and enhances communication. 

4. Describe the person-centered planning process in your state. 
54

6. Program Integrity - Required 

SAMHSA has placed a strong emphasis on ensuring that block grant funds are expended in a 

manner consistent with the statutory and regulatory framework. This requires that SAMHSA 

and the states have a strong approach to assuring program integrity. Currently, the primary 

goals of SAMHSA program integrity efforts are to promote the proper expenditure of block 

grant funds, improve block grant program compliance nationally, and demonstrate the effective

use of block grant funds. 

While some states have indicated an interest in using block grant funds for individual co-pays 

deductibles and other types of co-insurance for M/SUD services, SAMHSA reminds states of 

restrictions on the use of block grant funds outlined in 42 U.S.C. §§ 300x–5 and 300x-31, 

including cash payments to intended recipients of health services and providing financial 

assistance to any entity other than a public or nonprofit private entity. Under 42 U.S.C. § 300x–

55(g), SAMHSA periodically conducts site visits to MHBG and SABG grantees to evaluate 

program and fiscal management. States will need to develop specific policies and procedures for 

assuring compliance with the funding requirements. Since MHBG funds can only be used for 

authorized services made available to adults with SMI and children with SED and SABG funds 

can only be used for individuals with or at risk for SUD. SAMHSA guidance on the use of block 

grant funding for co-pays, deductibles, and premiums can be found at: 

http://www.samhsa.gov/sites/default/files/grants/guidance-for-block-grant-funds-for-costsharing-assistance-for-private-health-insurance.pdf. States are encouraged to review the 

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

The MHBG and SABG resources are to be used to support, not supplant, services that will be

covered through the private and public insurance. In addition, SAMHSA will work with CMS 

and states to identify strategies for sharing data, protocols, and information to assist our 

program integrity efforts. Data collection, analysis, and reporting will help to ensure that 

MHBG and SABG funds are allocated to support evidence-based, culturally competent 

programs, primary substance use disorder prevention, treatment and recovery programs, and 

activities for adults with SMI and children with SED. 

States traditionally have employed a variety of strategies to procure and pay for M/SUD

services funded by the MHBG and SABG. State systems for procurement, contract 

management, financial reporting, and audit vary significantly. These strategies may include: 

(1) appropriately directing complaints and appeals requests to ensure that QHPs and Medicaid 

programs are including essential health benefits (EHBs) as per the state benchmark plan; (2) 

ensuring that individuals are aware of the covered M/SUD benefits; (3) ensuring that 

consumers of M/SUD services have full confidence in the confidentiality of their medical 

information; and (4) monitoring the use of M/SUD benefits in light of utilization review, 

medical necessity, etc. Consequently, states may have to become more proactive in ensuring 

that state-funded providers are enrolled in the Medicaid program and have the ability to 

determine if clients are enrolled or eligible to enroll in Medicaid. Additionally, compliance 

review and audit protocols may need to be revised to provide for increased tests of client 

eligibility and enrollment.
55

Please respond to the following: 

1) Does the state have a specific policy and/or procedure for assuring that the federal program 

requirements are conveyed to intermediaries and providers? Yes No

2) Does the state provide technical assistance to providers in adopting practices that promote 

compliance with program requirements, including quality and safety standards? 

Yes No

3) Does the state have any activities related to this section that you would like to highlight?

Currently, the primary goals of SAMHSA program integrity efforts are to promote the proper 

expenditure of block grant funds, improve block grant program compliance nationally, and 

demonstrate the effective use of block grant funds. 

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

7. Tribes - Requested

The federal government has a unique obligation to help improve the health of American 

Indians and Alaska Natives through the various health and human services programs 

administered by HHS. Treaties, federal legislation, regulations, executive orders, and 

Presidential memoranda support and define the relationship of the federal government with 

federally recognized tribes, which is derived from the political and legal relationship that 

Indian tribes have with the federal government and is not based upon race. SAMHSA is 

required by the 2009 Memorandum on Tribal Consultation36 to submit plans on how it will 

engage in regular and meaningful consultation and collaboration with tribal officials in the

development of federal policies that have tribal implications. 

Improving the health and well-being of tribal nations is contingent upon understanding their

specific needs. Tribal consultation is an essential tool in achieving that understanding. 

36

https://www.energy.gov/sites/prod/files/Presidential%20Memorandum%20Tribal%20Consultation%20%282009%2

9.pdf
56

Consultation is an enhanced form of communication, which emphasizes trust, respect, and 

shared responsibility. It is an open and free exchange of information and opinion among 

parties, which leads to mutual understanding and comprehension. Consultation is integral to a

deliberative process that results in effective collaboration and informed decision-making with 

the ultimate goal of reaching consensus on issues. 

In the context of the block grant funds awarded to tribes, SAMHSA views consultation as a 

government-to-government interaction and should be distinguished from input provided by 

individual tribal members or services provided for tribal members whether on or off tribal 

lands. Therefore, the interaction should be attended by elected officials of the tribe or their

designees and by the highest possible state officials. As states administer health and human 

services programs that are supported with federal funding, it is imperative that they consult with 

tribes to ensure the programs meet the needs of the tribes in the state. In addition to general 

stakeholder consultation, states should establish, implement, and document a process for 

consultation with the federally recognized tribal governments located within or governing tribal 

lands within their borders to solicit their input during the block grant planning process. 

Evidence that these actions have been performed by the state should be reflected throughout the 

state’s plan. Additionally, it is important to note that approximately 70 percent of American 

Indians and Alaska Natives do not live on tribal lands. The SMHAs, SSAs, and tribes should 

collaborate to ensure access and culturally competent care for all American Indians and Alaska 

Natives in the states. 

States shall not require any tribe to waive its sovereign immunity in order to receive funds or 

for services to be provided for tribal members on tribal lands. If a state does not have any 

federally recognized tribal governments or tribal lands within its borders, the state should make 

a declarative statement to that effect. 

Please respond to the following items:

1. How many consultation sessions has the state conducted with federally recognized tribes?

2. What specific concerns were raised during the consultation session(s) noted above? 
57

3. Does the state have any activities related to this section that you would like to highlight?

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

8. Primary Prevention-Required (SABG only)

SABG statute requires states to spend not less than 20 percent of their SABG allotment on 

primary prevention strategies directed at individuals not identified to need treatment. While 

primary prevention set-aside funds must be used to fund strategies that have a positive impact on 

the prevention of substance use, it is important to note that many evidence-based primary 

substance use disorder prevention strategies also have a positive impact on other health and 

social outcomes such as education, juvenile justice involvement, violence prevention, and mental 

health.

The SABG statute requires states to develop a comprehensive primary prevention program that 

includes activities and services provided in a variety of settings. The program must target both 

the general population and sub-groups that are at high risk for substance misuse. The program 

must include, but is not limited to, the following strategies:

1. Information dissemination providing awareness and knowledge of the nature, extent, and 

effects of alcohol, tobacco, and drug use, abuse, and addiction on individuals families and 

communities.

2. Education aimed at affecting critical life and social skills, such as decision making, refusal 

skills, critical analysis, and systematic judgment abilities. 

3. Alternative programs that provide for the participation of target populations in activities 

that exclude alcohol, tobacco, and other drug use. 

4. Problem identification and Referral to Education, that aims at identification of those 

who have indulged in illegal/age inappropriate use of tobacco or alcohol, and those 

individuals who have indulged in first use of illicit drugs, in order to assess if the behavior 

can be reversed by education to prevent further use. 

5. Community-based processes that include organizing, planning, and enhancing 

effectiveness of program, policy, and practice implementation, interagency collaboration, 

coalition building, and networking; and 
58

6. Environmental strategies that establish or change written and unwritten community 

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

alcohol, tobacco, and other drugs used in the general population. 

In implementing the comprehensive primary prevention program, states should use a variety of 

strategies that target populations with different levels of risk, including the IOM classified 

universal, selective, and indicated strategies.

Please respond to the following questions: 

Assessment

1. Does your state have an active State Epidemiological and Outcomes Workgroup (SEOW)? 

a) Yes No

2. Does your state collect the following types of data as part of its primary prevention needs 

assessment process? (check all that apply):

a) Data on consequences of substance-using behaviors 

b) Substance-using behaviors 

c) Intervening variables (including risk and protective factors) 

d) Other (please list) 

3. Does your state collect needs assessment data that include analysis of primary prevention 

needs for the following population groups? (check all that apply):

a) Children (under age 12) 

b) Youth (ages 12-17) 

c) Young adults/college age (ages 18-26) 

d) Adults (ages 27-54) 

e) Older adults (age 55 and above) 

f) Cultural/ethnic minorities

g) Sexual/gender minorities 

h) Rural communities

i) Other (please list) 
59

4. Does your state use data from the following sources in its primary prevention needs 

assessment? (check all that apply):

a) Archival indicators (Please list) 

b) National Survey on Drug Use and Health (NSDUH) 

c) Behavioral Risk Factor Surveillance System (BRFSS)

d) Youth Risk Behavior Surveillance System (YRBS) 

e) Monitoring the Future 

f) Communities that Care

g) State-developed survey instrument) 

h) Other (please list) 

5. Does your state use needs assessment data to make decisions about the allocation of SABG 

primary prevention funds? 

a) Yes No

i) If yes, (please explain in the box below) 

ii) If no, please explain how SABG funds are allocated: 
60

6. Does your state integrate cultural competency into the assessment step?

a) Yes No

i) If yes, please explain in the box below. 

ii) If no, please explain in the box below. 

7. Does your state integrate sustainability into the assessment step?

a) Yes No

i) If yes, please explain in the box below. 

ii) If no, please explain in the box below. 
61

Capacity Building

1. Does your state have a statewide licensing or certification program for the primary substance 

use disorder prevention workforce?

a) Yes (if yes, please describe) 

b) No

2. Does your state have a formal mechanism to provide training and technical assistance to the 

primary substance use disorder prevention workforce?

a) Yes (if yes, please describe mechanism used) 

b) No

3. Does your state have a formal mechanism to assess community readiness to implement 

prevention strategies?

a) Yes (if yes, please describe mechanism used) 

b) No
62

4. Does your state integrate cultural competency into the capacity building step?

a) Yes No

i) If yes, please explain in the box below. 

ii) If no, please explain in the box below. 

5. Does your state integrate sustainability into the capacity building step?

a) Yes No

i) If yes, please explain in the box below. 

ii) If no, please explain in the box below. 

Planning

1. Does your state have a strategic plan that addresses primary substance use disorder

prevention that was developed within the last five years? 

a) Yes (If yes, please attach the plan in BGAS)

b) No
63

2. Does your state use the strategic plan to make decisions about use of the primary prevention 

set-aside of the SABG?

a) Yes No

 Not applicable (no prevention strategic plan) 

3. Does your state’s prevention strategic plan include the following components? (check all 

that apply): 

a) Based on needs assessment datasets the priorities that guide the allocation of 

SABG primary prevention funds 

b) Timelines

c) Roles and responsibilities 

d) Process indicators

e) Outcome indicators 

f) Cultural competence component 

g) Sustainability component 

h) Other (please list) 

i) Not applicable/no prevention strategic plan 

4. Does your state have an Advisory Council that provides input into decisions about the use of 

SABG primary prevention funds? 

a) Yes No

5. Does your state have an active Evidence-Based Workgroup that makes decisions about 

appropriate strategies to be implemented with SABG primary prevention funds? 

a) Yes No 

b) If yes, please describe the criteria the Evidence-Based Workgroup uses to determine 

which programs, policies, and strategies are evidence based? 

6. Does your state integrate cultural competency into the planning step?
64

a) Yes No

i) If yes, please explain in the box below. 

ii) If no, please explain in the box below. 

7. Does your state integrate sustainability into the planning step?

a) Yes No

i) If yes, please explain in the box below. 

ii) If no, please explain in the box below. 

Implementation

1. States distribute SABG primary prevention funds in a variety of different ways. Please check 

all that apply to your state: 

a) SSA staff directly implements primary prevention programs and strategies.

b) The SSA has statewide contracts (e.g. statewide needs assessment contract, statewide 

workforce training contract, statewide media campaign contract).

c) The SSA funds regional entities that are autonomous in that they issue and manage 

their own sub-contracts.

d) The SSA funds regional entities that provide training and technical assistance.

e) The SSA funds regional entities to provide prevention services. 
65

f) The SSA funds county, city, or tribal governments to provide prevention services. 

g) The SSA funds community coalitions to provide prevention services. 

h) The SSA funds individual programs that are not part of a larger community effort. 

i) The SSA directly funds other state agency prevention programs. 

j) Other (please describe)

2. Please list the specific primary prevention programs, practices, and strategies that are funded 

with SABG primary prevention dollars in each of the six prevention strategies. Please see 

the introduction above for definitions of the six strategies: 

a) Information Dissemination: 

b) Education: 

c) Alternatives:

 

d) Problem Identification and Referral to Education: 

 

e) Community-Based Processes:

f) Environmental: 

3. Does your state have a process in place to ensure that SABG dollars are used only to fund 

primary prevention services not funded through other means? 

a) Yes (if so, please describe) 
66

b) No 

4. Does your state integrate cultural competency into the implementation step?

a) Yes No

i) If yes, please explain in the box below. 

ii) If no, please explain in the box below. 

5. Does your state integrate sustainability into the implementation step?

a) Yes No

i) If yes, please explain in the box below. 

ii) If no, please explain in the box below. 

Evaluation 

1. Does your state have an evaluation plan for primary substance use disorder prevention that 

was developed within the last five years? 
67

a) Yes (If yes, please attach the plan in BGAS)

b) No 

2. Does your state’s prevention evaluation plan include the following components? (check all 

that apply) 

a) Establishes methods for monitoring progress towards outcomes, such as targeted 

benchmarks 

b) Includes evaluation information from sub-recipients

c) Includes SAMHSA National Outcome Measurement (NOMs) requirements

d) Establishes a process for providing timely evaluation information to stakeholders 

e) Formalizes processes for incorporating evaluation findings into resource allocation 

and decision-making 

f) Other (please describe)

g) Not applicable/no prevention evaluation plan 

3. Please check those process measures listed below that your state collects on its SABG funded 

prevention services: 

a) Numbers served

b) Implementation fidelity

c) Participant satisfaction

d) Number of evidence-based programs/practices/policies implemented

e) Attendance

f) Demographic information 

g) Other (please describe)

4. Please check those outcome measures listed below that your state collects on its SABG 

funded prevention services: 

a) 30-day use of alcohol, tobacco, prescription drugs, etc.

b) Heavy use 

 Binge use 

 Perception of harm 

c) Disapproval of use 
68

d) Consequences of substance use (e.g. alcohol-related motor vehicle crashes, drugrelated mortality)

e) Other (please describe)

5. Does your state integrate cultural competency into the evaluation step?

a) Yes No

i) If yes, please explain in the box below. 

ii) If no, please explain in the box below. 

6. Does your state integrate sustainability into the evaluation step?

a) Yes No

i) If yes, please explain in the box below. 

ii) If no, please explain in the box below. 

9. Statutory Criterion for MHBG (Required for MHBG)
69

Criterion 1: Comprehensive Community-Based Mental Health Service Systems

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

care for individuals with mental illness, including those with co-occurring M/SUD. Describes 

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

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

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

1. Describe available services and resources in order to enable individuals with mental illness, 

including those with co-occurring M/SUD to function outside of inpatient or residential 

institutions to the maximum extent of their capabilities.

2. Does your state coordinate the following services under comprehensive community-based 

mental health service systems?

a) Physical health

Yes No

b) Mental Health

Yes No

c) Rehabilitation services

Yes No

d) Employment services 

Yes No

e) Housing services 

Yes No

f) Educational services

Yes No

g) Substance misuse prevention and SUD treatment services

Yes No

h) Medical and dental services

Yes No

i) Support services 

Yes No

j) Services provided by local school systems under the Individuals with Disabilities 

Education Act (IDEA) 

Yes No

k) Services for persons with co-occurring M/SUDs 

Yes No

Please describe or clarify the services coordinated, as needed (for example, best practices, 
70

service needs, concerns, etc.) 

3. Describe your state’s case management services 

4. Describe activities intended to reduce hospitalizations and hospital stays. 

Criterion 2: Mental Health System Data Epidemiology 

Contains an estimate of the incidence and prevalence in the state of SMI among adults and SED 

among children; and have quantitative targets to be achieved in the implementation of the system 

of care described under Criterion 1. 

In order to complete column B of the table, please use the most recent SAMHSA prevalence 

estimate or other federal/state data that describes the populations of focus. 

Column C requires that the state indicate the expected incidence rate of individuals with 

SMI/SED who may require services in the state’s M/SUD system 

MHBG Estimate of statewide prevalence and incidence rates of individuals with SMI/SED

Target Population (A) Statewide prevalence (B) Statewide incidence (C)

1. Adults with SMI

2. Children with SED 

Describe the process by which your state calculates prevalence and incidence rates and provide 
71

an explanation as to how this information is used for planning purposes. If your state does not 

calculate these rates, but obtains them from another source, please describe. If your state does 

not use prevalence and incidence rates for planning purposes, indicate how system planning 

occurs in their absence. 

Criterion 3: Children’s Services

Provides for a system of integrated services in order for children to receive care for multiple 

needs. Does your state integrate the following services into a comprehensive system of care? 

a) Social Services

Yes No

b) Educational services, including services provided under IDE 

Yes No

c) Juvenile justice services

Yes No

d) Substance misuse prevention and SUD treatment services

Yes No

e) Health and mental health services

Yes No

f) Establishes defined geographic area for the provision of the services of such system

Yes No

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

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

a. Describe your state’s targeted services to rural population. 

b. Describe your state’s targeted services to the homeless population. 
72

c. Describe your state’s targeted services to the older adult population. 

Criterion 5: Management Systems

States describe their financial resources, staffing, and training for mental health services 

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

regarding SMI and SED; and how the state intends to expend this grant for the fiscal years 

involved. 

Describe your state’s management systems.

Telehealth is a mode of service delivery that has been used in clinical settings for over 60 years 

and empirically studied for just over 20 years. Telehealth is not an intervention itself, but rather 

a mode of delivering services. This mode of service delivery increases access to screening, 

assessment, treatment, recovery supports, crisis support, and medication management across 

diverse behavioral health and primary care settings. Practitioners can offer telehealth through 

synchronous and asynchronous methods. A priority topic for SAMHSA is increasing access to 

treatment for SMI and SUD using telehealth modalities. Telehealth is the use of 

telecommunication technologies and electronic information to provide care and facilitate clientprovider interactions. Practitioners can use telehealth with a hybrid approach for increased 

flexibility. For instance, a client can receive both in-person and telehealth visits throughout their 

treatment process depending on their needs and preferences. Telehealth methods can be 

implemented during public health emergencies (e.g., pandemics, infectious disease outbreaks, 

wildfires, flooding, tornadoes, hurricanes) or to extend networks of providers (e.g., tapping into 

out-of-state providers to increase capacity). They can also expand capacity to provide direct 

client care when in-person, face-to-face interactions are not possible due to geographic barriers 

or a lack of providers or treatments in a given area. However, implementation of telehealth 

methods should not be reserved for emergencies or to serve as a bridge between providers and 

rural or underserved areas. Telehealth can be integrated into an organization’s standard 

practices, providing low-barrier pathways for clients and providers to connect to and assess 

treatment needs, create treatment plans, initiate treatment, and provide long-term continuity of 

care. States are encouraged to access, the SAMHSA Evidence Based Resource Guide, 

Telehealth for the Treatment of Serious Mental Illness and Substance Use Disorders. 
73

Describe your state’s current telehealth capabilities, how your state uses telehealth modalities to 

treat individuals with SMI/SED, and any plans/initiatives to expand its use. 
74

10. Substance Use Disorder Treatment - Required for SABG

Criterion 1: Prevention and Treatment Services - Improving Access and Maintaining a 

Continuum of Services to Meet State Needs. 

Improving access to treatment services

1. Does your state provide: 

a) A full continuum of services: 

i) Screening

Yes No

ii) Education 

Yes No

iii) Brief intervention

Yes No

iv) Assessment

Yes No

v) Detox (inpatient/social)

Yes No

vi) Outpatient 

Yes No

vii) Intensive outpatient 

Yes No

viii) Inpatient/residential

Yes No

ix) Aftercare

Yes No

x) Recovery support 

Yes No

b) Services for special populations: 

Targeted services for veterans? 

Yes No

Adolescents? 

Yes No

Older adults? 

Yes No

Medication-Assisted Treatment (MAT)? 

Yes No

Criterion 2: Improving Access and Addressing Primary Prevention – see Section 8
75

Criterion 3: Pregnant Women and Women with Dependent Children (PWWDC)

1. Does your state meet the performance requirement to establish and or maintain new 

programs or expand programs to ensure treatment availability? 

a) Yes No

2. Does your state make prenatal care available to PWWDC receiving services, either directly 

or through an arrangement with public or private nonprofit entities?

a) Yes No

3. Does your state have an agreement to ensure pregnant women are given preference in 

admission to treatment facilities or make available interim services within 48 hours, 

including prenatal care? 

a) Yes No

4. Does your state have an arrangement for ensuring the provision of required supportive 

services?

a) Yes No

5. Has your state identified a need for any of the following: 

a) Open assessment and intake scheduling?

Yes No

b) Establishment of an electronic system to identify available treatment slots?

Yes No

 c) Expanded community network for supportive services and healthcare?

Yes No

d) Inclusion of recovery support services?

Yes No

e) Health navigators to assist clients with community linkages?

Yes No

f) Expanded capability for family services, relationship restoration, and custody issues?

Yes No

g) Providing employment assistance?

Yes No

h) Providing transportation to and from services?

Yes No

i) Educational assistance?

Yes No

6. States are required to monitor program compliance related to activities and services for 

PWWDC. Please provide a detailed description of the specific strategies used by the state to 

identify compliance issues and corrective actions required to address identified problems. 

 
76

Criteria 4, 5 and 6: Persons Who Inject Drugs (PWID), Tuberculosis (TB), Human 

Immunodeficiency Virus (HIV), Hypodermic Needle Prohibition, and Syringe Services 

Program 

 

Persons Who Inject Drugs (PWID) 

1. Does your state fulfill the: 

a) 90 percent capacity reporting requirement?

Yes No

b) 14-120 day performance requirement with provision of interim services?

Yes No

c) Outreach activities?

Yes No

d) Syringe services programs? 

 Yes No

e) Monitoring requirements as outlined in the authorizing statute and implementing 

regulation?

Yes No 

2. Has your state identified a need for any of the following:

a) Electronic system with alert when 90 percent capacity is reached?

Yes No 

b) Automatic reminder system associated with 14-120 day performance requirement?

Yes No 

c) Use of peer recovery supports to maintain contact and support?

Yes No

d) Service expansion to specific populations (e.g., military families, veterans, adolescents, 

older adults)?

Yes No

3. States are required to monitor program compliance related to activities and services for 

PWID. Please provide a detailed description of the specific strategies used by the state to 

identify compliance issues and corrective actions required to address identified problems. 
77

Tuberculosis (TB) 

1. Does your state currently maintain an agreement, either directly or through arrangements 

with other public and nonprofit private entities to make tuberculosis services available to 

individuals receiving SUD treatment and to monitor the service delivery? 

a) Yes No 

2. Has your state identified a need for any of the following: 

a) Business agreement/MOU with primary healthcare providers? 

Yes No 

b) Cooperative agreement/MOU with public health entity for testing and treatment? 

Yes No

c) Established co-located SUD professionals within FQHCs? 

Yes No

3. States are required to monitor program compliance related to tuberculosis services made 

available to individuals receiving SUD treatment. Please provide a detailed description of 

the specific strategies used by the state to identify compliance issues and corrective actions 

required to address identified problems. 

Early Intervention Services for HIV (For “Designated States” Only) 

1. Does your state currently have an agreement to provide treatment for persons with SUD with 

an emphasis on making available within existing programs early intervention services for 

HIV in areas that have the greatest need for such services and monitoring such service 

delivery? 

Yes No

2. Has your state identified a need for any of the following: 

a) Establishment of EIS-HIV service hubs in rural areas? 

Yes No

b) Establishment or expansion of telehealth and social media support services? 

Yes No

c) Business agreement/MOU with established community agencies/organizations serving 

persons with HIV/AIDS? 

Yes No
78

Syringe Service Programs 

1. Does your state have in place an agreement to ensure that SABG funds are NOT expended to 

provide individuals with hypodermic needles or syringes (42 U.S.C.§ 300x-31(a)(1)F)?

Yes No

2) Do any of the programs serving PWID have an existing relationship with a Syringe Services 

(Needle Exchange) Program?

Yes No

3) Do any of your programs use SABG funds to support elements of a Syringe Services 

Program?

a) Yes No

b) If yes, please provide a brief description of the elements and the arrangement

Criteria 8, 9 and 10: Service System Needs, Service Coordination, Charitable Choice, 

Referrals, Patient Records, and Independent Peer Review

Service System Needs

1. Does your state have an agreement in place to ensure the state has conducted a statewide

assessment of need, which defines prevention, and treatment authorized services available, 

identified gaps in service, and outlines the state’s approach for improvement? 

Yes No

2. Has your state identified a need for any of the following: 

a) Workforce development efforts to expand service access? 

Yes No

b) Establishment of a statewide council to address gaps and formulate a strategic plan to 

coordinate services?

Yes No

c) Establish a peer recovery support network to assist in filling the gaps?

Yes No

d) Incorporate input from special populations (military families, service members, veterans, 

tribal entities, older adults, sexual and gender minorities)

Yes No
79

e) Formulate formal business agreements with other involved entities to coordinate services 

to fill gaps in the system, such as primary healthcare, public health, VA, and community 

organizations

Yes No

f) Explore expansion of services for:

i) MAT

(1) Yes No

ii) Telehealth

(1) Yes No

iii) Social media outreach

(1) Yes No

Service Coordination

1. Does your state have a current system of coordination and collaboration related to the 

provision of person-centered and person-directed care?

Yes No

2. Has your state identified a need for any of the following: 

a) Identify MOUs/Business Agreements related to coordinate care for persons receiving 

SUD treatment and/or recovery services

Yes No

b) Establish a program to provide trauma-informed care

Yes No

c) Identify current and perspective partners to be included in building a system of care, such 

as FQHCs, primary healthcare, recovery community organizations, juvenile justice 

system, adult criminal justice system, and education 

Yes No

Charitable Choice

1. Does your state have in place an agreement to ensure the system can comply with the 

services provided by nongovernment organizations (42 U.S.C.§ 300x-65, 42 CF Part 54

(§54.8(b) and §54.8(c)(4)) and 68 FR 56430-56449)? 

Yes No

2. Does your state provide any of the following: 

a) Notice to Program Beneficiaries? 

Yes No
80

b) An organized referral system to identify alternative providers? 

Yes No

 c) A system to maintain a list of referrals made by religious organizations? 

Yes No

Referrals

1. Does your state have an agreement to improve the process for referring individuals to the 

treatment modality that is most appropriate for their needs? 

Yes No

2. Has your state identified a need for any of the following: 

a) Review and update of screening and assessment instruments? 

Yes No

b) Review of current levels of care to determine changes or additions? 

Yes No

c) Identify workforce needs to expand service capabilities? 

Yes No

d) Conduct cultural awareness training to ensure staff sensitivity to client cultural 

orientation, environment, and background? 

Yes No

Patient Records

1. Does your state have an agreement to ensure the protection of client records? 

a) Yes No

2. Has your state identified a need for any of the following: 

a) Training staff and community partners on confidentiality requirements? 

Yes No

b) Training on responding to requests asking for acknowledgement of the presence of 

clients? 

Yes No

c) Updating written procedures which regulate and control access to records? 

Yes No

d) Review and update of the procedure by which clients are notified of the confidentiality of 

their records include the exceptions for disclosure? 

Yes No
81

Independent Peer Review

1. Does your state have an agreement to assess and improve, through independent peer review, 

the quality and appropriateness of treatment services delivered by providers? 

a) Yes No

2. Section 1943(a) of Title XIX, Part B, Subpart III of the Public Health Service Act (42 

U.S.C.§ 300x-52(a)) and 45 § CFR 96.136 require states to conduct independent peer review 

of not fewer than 5 percent of the block grant sub-recipients providing services under the 

program involved. 

a) Please provide an estimate of the number of block grant sub-recipients identified to 

undergo such a review during the fiscal year(s) involved 

3. Has your state identified a need for any of the following? 

a) Development of a quality improvement plan? 

Yes No

b) Establishment of policies and procedures related to independent peer review? 

Yes No

c) Development of long-term planning for service revision and expansion to meet the needs 

of specific populations 

Yes No

4. Does your state require a block grant sub-recipient to apply for and receive accreditation 

from an independent accreditation organization, such as the Commission on the 

Accreditation of Rehabilitation Facilities (CARF), The Joint Commission, or similar 

organization as an eligibility criterion for block grant funds? 

a) Yes No

b) If Yes, please identify the accreditation organization(s) 

i) Commission on the Accreditation of Rehabilitation Facilities

ii) The Joint Commission

iii) Other (please specify) _______________________ 

Criterion 7 and 11: Group Homes for Persons In Recovery and Professional Development 

 

Group Homes

1. Does your state have an agreement to provide for and encourage the development of group 

homes for persons in recovery through a revolving loan program?

Yes No
82

2. Has your state identified a need for any of the following:

a) Implementing or expanding the revolving loan fund to support recovery home 

development as part of the expansion of recovery support service?

Yes No

b) Implementing MOUs to facilitate communication between block grant service providers 

and group homes to assist in placing clients in need of housing?

Yes No

Professional Development

1. Does your state have an agreement to ensure that prevention, treatment, and recovery 

personnel operating in the state’s substance use disorder prevention, treatment and recovery 

systems have an opportunity to receive training on an ongoing basis, concerning:

a) Recent trends in SUD in the state?

Yes No

b) Improved methods and evidence-based practices for providing substance use disorder 

prevention and treatment services?

Yes No

c) Performance-based accountability?

Yes No

d) Data collection and reporting requirements?

Yes No

2. Has your state identified a need for any of the following:

a) A comprehensive review of the current training schedule and identification of additional

training needs?

Yes No

b) Addition of training sessions designed to increase employee understanding of recovery

support services?

Yes No

c) Collaborative training sessions for employees and community agencies’ staff to 

coordinate and increase integrated services?

Yes No

d) State office staff training across departments and divisions to increase staff knowledge of 

programs and initiatives, which contribute to increased collaboration and decreased 

duplication of effort? 

Yes No
83

3. Has your state utilized the Regional Prevention, Treatment and/or Mental Health Training 

and Technical Assistance Centers (TTCs)?

a) Prevention TTC? 

Yes No

b) Mental Health TTC?

Yes No

c) Addiction TTC? 

Yes No

d) State Targeted Response TTC?

Yes No

Waivers 

Upon the request of a state, the Secretary may waive the requirements of all or part of the 

sections 1922(c), 1923, 1924 and 1928 (42 U.S.C. § 300x-32(f)).

1. Is your state considering requesting a waiver of any requirements related to: 

a) Allocations Regarding Women 

 Yes No

2. Requirements Regarding Tuberculosis Services and Human Immunodeficiency Virus 

a) Tuberculosis 

Yes No

b) Early Intervention Services Regarding HIV 

Yes No

3. Additional Agreements 

a) Improvement of Process for Appropriate Referrals for Treatment 

Yes No

b) Professional Development 

Yes No

c) Coordination of Various Activities and Services 

Yes No

Please provide a link to the state administrative regulations that govern the Mental Health 

and Substance Use Disorder Programs.
84

11. Quality Improvement Plan- Requested

In previous block grant applications, SAMHSA asked states to base their administrative

operations and service delivery on principles of Continuous Quality Improvement/Total Quality 

Management (CQI/TQM). These CQI processes should identify and track critical outcomes and 

performance measures, based on valid and reliable data, consistent with the NBHQF, which will 

describe the health and functioning of the mental health and addiction systems. The CQI 

processes should continuously measure the effectiveness of services and supports and ensure that 

they continue to reflect this evidence of effectiveness. The state’s CQI process should also track 

programmatic improvements using stakeholder input, including the general population and 

individuals in treatment and recovery and their families. In addition, the CQI plan should 

include a description of the process for responding to emergencies, critical incidents, complaints, 

and grievances. 

1. Has your state modified its CQI plan from FFY 2020-FFY 2021? 

a) Yes No

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

12. Trauma -Requested

Trauma37 is a widespread, harmful, and costly public health problem. Causes include violence, 

abuse, neglect, loss, disaster, war and other emotionally harmful and/or life-threatening 

experiences. Trauma has no boundaries with regard to age, gender, socioeconomic status, race, 

ethnicity, geography, or sexual orientation. It is an almost universal experience of people with 

mental and substance use difficulties. The need to address trauma is increasingly viewed as an 

important component of effective M/SUD service delivery. Additionally, it has become evident 

that addressing trauma requires a multi-pronged, multi-agency public health approach inclusive 

of public education and awareness, prevention and early identification, and effective traumaspecific assessment and treatment. To maximize these efforts they need to be provided in an 

organizational or community context that is trauma informed. 

Individuals with experiences of trauma are found in multiple service sectors, not just in M/SUD 

services. People in the juvenile and criminal justice system have high rates of mental illness and 

substance use disorders and personal histories of trauma. Children and families in the child

37 Definition of Trauma: Individual trauma results from an event, series of events, or set of circumstances that is experienced by 

an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s 

functioning and mental, physical, social, emotional, or spiritual well-being.
85

welfare system similarly experience high rates of trauma and associated M/SUD problems. 

Many patients in primary, specialty, emergency and rehabilitative health care similarly have 

significant trauma histories, which has an impact on their health and their responsiveness to 

health interventions. Schools are now recognizing that the impact of exposure to trauma and 

violence among their students makes it difficult to learn and meet academic goals. Communities 

and neighborhoods experience trauma and violence. For some these are rare events and for 

others these are daily events that children and families are forced to live with. These children 

and families remain especially vulnerable to trauma-related problems, often are in resource poor 

areas, and rarely seek or receive M/SUD care. States should work with these communities to 

identify interventions that best meet the needs of these residents. 

In addition, the public institutions and service systems that are intended to provide services and 

supports for individuals are often re-traumatizing, making it necessary to rethink doing “business 

as usual.” These public institutions and service settings are increasingly adopting a traumainformed approach. A trauma-informed approach is distinct from trauma-specific assessments 

and treatments. Rather, trauma-informed refers to creating an organizational culture or climate 

that realizes the widespread impact of trauma, recognizes the signs and symptoms of trauma in 

clients and staff, responds by integrating knowledge about trauma into policies and procedures, 

and seeks to actively resist re-traumatizing clients and staff. This approach is guided by key 

principles that promote safety, trustworthiness and transparency, peer support, empowerment, 

collaboration, and sensitivity to cultural and gender issues. A trauma-informed approach may 

incorporate trauma-specific screening, assessment, treatment, and recovery practices or refer 

individuals to these appropriate services. 

It is suggested that states refer to SAMHSA’s guidance for implementing the trauma-informed 

approach discussed in the Concept of Trauma38 paper.

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

system:

1. Does the state have a plan or policy for M/SUD providers that guide how they will address 

individuals with trauma-related issues? Yes No

2. Does the state provide information on trauma-specific assessment tools and interventions for 

M/SUD providers? 

Yes No

3. Does the state have a plan to build the capacity of M/SUD providers and organizations to 

implement a trauma-informed approach to care? 

Yes No

4. Does the state encourage employment of peers with lived experience of trauma in developing 

trauma-informed organizations? 

Yes No

38 Ibid
86

5) Does the state have any activities related to this section that you would like to highlight. 

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

13. Criminal and Juvenile Justice - Requested

More than half of all prison and jail inmates meet criteria for having mental health problems, six 

in ten meet criteria for a substance use problem, and more than one-third meet criteria for having 

co-occurring mental and substance use problems. Youth in the juvenile justice system often 

display a variety of high-risk characteristics that include inadequate family support, school 

failure, negative peer associations, and insufficient use of community-based services. Most 

adjudicated youth released from secure detention do not have community follow-up or 

supervision; therefore, risk factors remain unaddressed. 39 

Successful diversion of adults and youth from incarceration or re-entering the community from 

detention is often dependent on engaging in appropriate M/SUD treatment. Some states have 

implemented such efforts as mental health, veteran and drug courts, Crisis Intervention 

Training (CIT) and re-entry programs to help reduce arrests, imprisonment, and recidivism.40

A diversion program places youth in an alternative program, rather than processing them in the 

juvenile justice system. States should place an emphasis on screening, assessment, and 

services provided prior to adjudication and/or sentencing to divert persons with M/SUD from 

correctional settings. States should also examine specific barriers such as a lack of 

identification needed for enrollment Medicaid and/or the Health Insurance Marketplace; loss 

of eligibility for Medicaid resulting from incarceration; and care coordination for individuals 

with chronic health conditions, housing instability, and employment challenges. Secure 

custody rates decline when community agencies are present to advocate for alternatives to 

detention. 

The MHBG and SABG may be especially valuable in supporting care coordination to promote 

39 Journal of Research in Crime and Delinquency: Identifying High-Risk Youth: Prevalence and Patterns of Adolescent Drug

Victims, Judges, and Juvenile Court Reform Through Restorative Justice. Dryfoos, Joy G. 1990, Rottman, David, and Pamela 

Casey, McNiel, Dale E., and Renée L. Binder. OJJDP Model Programs Guide. 40 http://csgjusticecenter.org/mental-health/
87

pre-adjudication or pre-sentencing diversion, providing care during gaps in enrollment after 

incarceration, and supporting other efforts related to enrollment. 

Please respond to the following items:

1. Does the state (SMHA and SSA) have a plan for coordinating with the criminal and juvenile 

justice systems on diversion of individuals with M/SUD from incarceration to community 

treatment, and for those incarcerated, a plan for re-entry into the community that includes 

connecting to M/SUD services? 

Yes No 

2. Does the state have a plan for working with law enforcement to deploy emerging strategies 

(e.g. civil citations, mobile crisis intervention, M/SUD provider ride-along, CIT, linkage with 

treatment services, etc.) to reduce the number of individuals with mental and/or substance 

use problems in jails and emergency rooms? 

Yes No

3. Does the state provide cross-trainings for M/SUD providers and criminal/juvenile justice 

personnel to increase capacity for working with individuals with M/SUD issues involved in 

the justice system? 

Yes No

4. Does the state have an inter-agency coordinating committee or advisory board that addresses 

criminal and juvenile justice issues and that includes the SMHA, SSA, and other 

governmental and non-governmental entities to address M/SUD and other essential domains 

such as employment, education, and finances? 

Yes No

5. Does the state have any activities related to this section that you would like to highlight? 

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

14. Medication Assisted Treatment – Requested (SABG only)

There is a voluminous literature on the efficacy of medication-assisted treatment (MAT); the use 

of FDA approved medication; counseling; behavioral therapy; and social support services, in the 

treatment of substance use disorders. However, many treatment programs in the U.S. offer only 

abstinence-based treatment for these conditions. The evidence base for MAT for SUDs is 

described in SAMHSA TIPs 40[1], 43[2], 45[3], and 49[4]. 
88

SAMHSA strongly encourages that the states require treatment facilities providing clinical care 

to those with SUD demonstrate that they both have the capacity and staff expertise to use MAT 

or have collaborative relationships with other providers to provide the appropriate MAT 

services clinically needed. 

Individuals with SUD who have a disorder for which there is an FDA-approved medication 

treatment should have access to those treatments based upon each individual patient’s needs. 

In addition, SAMHSA also encourages states to require the use of MAT for SUD for opioid use, 

alcohol use, and tobacco use disorders where clinically appropriate. 

SAMHSA is asking for input from states to inform SAMHSA’s activities.

Please respond to the following: 

1. Has the state implemented a plan to educate and raise awareness within SUD treatment 

programs regarding MAT for substance use disorders? 

Yes No

2. Has the state implemented a plan to educate and raise awareness of the use of MAT within

special target audiences, particularly pregnant women? 

Yes No

3. Does the state purchase any of the following medication with block grant funds? 

a) Methadone 

b) Buprenorphine; Buprenorphine/naloxone 

c) Disulfiram

d) Acamprosate

e) Naltrexone (oral, IM)

f) Naloxone 

4.Does the state have an implemented education or quality assurance program to assure that 

evidence-based MAT with the use of FDA-approved medications for treatment of substance 

use disorders are used appropriately*? 

Yes No

5. Does the state have any activities related to this section that you would like to highlight?

*Appropriate use is defined as use of medication for the treatment of a SUD, combining 

psychosocial treatments with approved medications, use of peer supports in the recovery process, 

safeguards against misuse and/or diversion of controlled substances used in treatment of 
89

substance use disorders, and advocacy with state payers. 

15. Crisis Services – Required for MHBG 

SAMHSA is directed by Congress through the Consolidated Appropriations Act, 2021 and the 

Coronavirus Response and Relief Supplement Appropriations Act, 2021 [P.L. 116-260], to set 

aside 5 percent of the MHBG allocation for each state to support evidence-based crisis systems. 

The appropriation bill includes the following budget language that outlines the new 5 percent setaside:

Furthermore, the Committee directs a new five percent set- aside of the total for 

evidence-based crisis care programs addressing the needs of individuals with serious 

mental illnesses and children with serious mental and emotional disturbances. The 

Committee directs SAMHSA to use the set-aside to fund, at the discretion of eligible 

States and Territories, some or all of a set of core crisis care elements including: 

centrally deployed 24/7 mobile crisis units, short-term residential crisis stabilization 

beds, evidence-based protocols for delivering services to individuals with suicide risk, 

and regional or State-wide crisis call centers coordinating in real time.

A crisis response system will have the capacity to prevent, recognize, respond, de-escalate, and

follow-up from crises across a continuum, from crisis planning, to early stages of support and 

respite, to crisis stabilization and intervention, to post-crisis follow-up and support for the 

individual and their family. SAMHSA expects that states will build on the emerging and 

growing body of evidence for effective community-based crisis-intervention and response 

systems. Given the multi-system involvement of many individuals with M/SUD issues, the crisis 

system approach provides the infrastructure to improve care coordination and outcomes, manage 

costs, and better invest resources. 

SAMHSA recently developed Crisis Services: Meeting Needs, Saving Lives, which includes 

“National Guidelines for Behavioral Health Crisis Care: Best Practice Toolkit” as well as other 

related National Association of State Mental Health Programs Directors (NASMHPD) papers on 

crisis services. Please note that this set aside funding is dedicated for the core set of crisis 

services as directed by Congress. Nothing precludes states from utilizing more than 5 percent of 

its MHBG funds for crisis services for individuals with SMI or children with SED. If states have 

other investments for crisis services, they are encouraged to coordinate those programs with 

programs supported by this new 5 percent set aside. This coordination will help ensure services 

for individuals are swiftly identified and are engaged in the core crisis care elements. 

When individuals experience a crisis related to mental health, substance use, and/or 

homelessness, a no-wrong door comprehensive crisis system should be put in place. Based on 

the National Guidelines, there are three major components to a comprehensive crisis system, and 

each must be in place for the system to be optimally effective. These three-core structural or 

programmatic elements are: Regional Crisis Call Center, Mobile Crisis Response Team, and 

Crisis Receiving and Stabilization Facilities.
90

Regional Crisis Call Center. In times of mental health or substance use crisis, 911 is typically 

called, which results in police or emergency medical services (EMS) dispatch. A regional crisis 

call center provides an alternative. Regional crisis call centers should be made available 

statewide, provide real-time access to a live mental health professional on a 24/7 basis, meet 

National Suicide Prevention Lifeline operational guidelines, and serve as “Air Traffic Control” 

to assess and determine the appropriate response to a crisis. In doing so, these centers should 

integrate and collaborate with existing 911 and 211 centers, as well as other applicable call 

centers, to ensure access to the appropriate level of crisis response. 211 centers serve as an entry 

point to crisis services in many states and provide information and referral to callers on where to 

obtain assistance from local and national social services, government agencies, and non-profit 

organizations. 

Mobile Crisis Response Team. Once a mental health crisis has been identified and a crisis line 

has been called, a mobile response is required if the crisis cannot be de-escalated by phone. In 

the current system, police are often dispatched to the location of the individual in crisis. But in an 

effective crisis system, two-person teams, including a clinician, should be dispatched to the 

location of the individual in crisis, accompanied by Emergency Medical Services (EMS) or 

police only as warranted. Ideally, peer support professionals would be integrated into this 

response. Assessment should take place on site, and the individual should be transported to the 

appropriate level of care, if needed, as deemed by the clinician and response team.

Crisis Receiving and Stabilization Facilities. In typical systems, EMS or police would 

transport the individual in crisis either to an ED or to a jail. Crisis Receiving and Stabilization 

Facilities provide a cost-effective alternative. These facilities should be available to accept 

individual walk-ins or drop-off 24/7 and should have a no-rejection policy. Particularly when 

police or EMS are dropping off an individual, the hand-off should be “warm” (welcoming) and 

efficient, and these facilities provide assessment and address mental health and substance use 

crisis issues. A warm hand-off establishes an initial face-to-face contact between the client and 

the behavioral clinician. The multi-disciplinary team, including peers, at the facility can work 

with the individual to coordinate next steps in care, to help prevent future mental health crises 

and repeat contacts with the system.

The public has become accustomed to calling 911 for any emergency because it is an easy 

number to remember and they receive a quick response. Many of the crisis systems in the United 

States continue to use 911 because either they are still building their crisis systems or because 

they have no mechanism to fund a call center separate from 911. However, they recognize that 

the sure way to minimize the involvement of law enforcement in a behavioral health crisis 

response is to divert calls from 911. There are basically three diversion models in operation at 

this time: (1) the 911-based system with dispatchers who forward calls to either the police 

department’s co-responder team (police officer with a behavioral health professional) or to their 

Crisis Intervention Team (CIT) with police officers who have received Mental Health First Aid 

and Crisis Intervention Training, including de-escalation methods and behavioral health 

symptoms; (2) the 911-based system with well-trained 911 dispatchers who triage calls to state 

or local crisis call centers for individuals who are not a threat to themselves or others; the call 

centers then refer to local mobile response teams (MRTs), also called mobile crisis teams 
91

(MCTs); and (3) State or local Crisis Call Centers with well-trained counselors who receive calls 

directly (without utilizing 911 at all) on their own toll-free numbers.

Currently, the National Suicide Prevention Lifeline (Lifeline) connects with local call centers 

throughout the United States. Call center staff is comprised of professionals and volunteers who 

are trained to utilize best practices in handling distress calls. Local call centers automatically 

perform a safety check for every call; if an imminent risk exists and cannot be deescalated, they 

forward the call to either 911 or to a local mobile crisis team for a response. If there is no 

imminent risk, the call center will work with the individual (or the person calling on their behalf) 

for as long as needed or, if necessary, dispatch a local MRT.

988 – 3-Digit behavioral health crisis number. The National Suicide Hotline Designation Act 

(P.L. 116-172) provides an opportunity to support the infrastructure, service and long-term 

funding for community and state 988 response, a national 3-digit behavioral health crisis number 

that was approved by the Federal Communications Commission in July 2020. It will replace the 

National Suicide Prevention Lifeline’s current number, 1800-273-TALK, and provide 

nationwide ease of access that connects callers in crisis to the Lifeline and Veterans Crisis Line. 

The 988 transition will provide support and expansion to the current Lifeline network and will 

continue utilizing the live-saving behavioral health crisis services that the Lifeline and Veterans 

Crisis Line centers currently provide. This bill was signed by President Trump on October 17, 

2020. 

Building Crisis Services Systems. Most communities across the United States have limited 

crisis services, but a few have an organized system of services that coordinate and collaborate to 

divert from jails, minimize the use of EDs, reduce hospital visits, and reduce the involvement of 

law enforcement. Those that have such systems did not create them overnight, but it involved 

dedicated individuals, collaboration, considerable planning, and creative methods of blending 

sources of funding. 

• Briefly narrate your state’s crisis system. Include a description of access to crisis call 

centers, availability of mobile crisis and behavioral health first responder services, 

utilization of crisis receiving and stabilization centers.

• In accordance with the guidelines below, identify the stages where the existing/proposed 

system will fit in.

 

Exploration 

Planning 

Installation Early 

Implementation 

Less than 25% 

of counties 

Partial 

Implementation

About 50% of 

counties 

Majority 

Implementation 

At least 75% of 

counties 

Program 

Sustainment 
92

Someone 

to talk to

Someone 

to respond

Place to 

go 

a) The Exploration stage: is the stage when states identify their communities’ needs, 

assess organizational capacity, identify how crisis services meet community needs, 

and understand program requirements and adaptation. 

b) The Installation stage: occurs once the state comes up with a plan and the state 

begins making the changes necessary to implement the crisis services based on the 

SAMHSA guidance. This includes coordination, training and community outreach 

and education activities. 

c) Initial Implementation stage: occurs when the state has the three-core crisis services 

in place and agencies begin to put into practice the SAMHSA guidelines. 

d) Full Implementation stage: occurs once staffing is complete, services are provided, 

and funding streams are in place. 

e) Program Sustainability stage: occurs when full implementation has been achieved, 

and quality assurance mechanisms are in place to assess the effectiveness and quality 

of the crisis services.

Other program implementation data that characterizes crisis services system development.

1. Someone to talk to: Crisis Call Capacity 

a. Number of locally based crisis call Centers in state

i. In the Suicide lifeline network 

ii. Not in the suicide lifeline network

b. Number of Crisis Call Centers with follow up protocols in place 

c. Percent of 911 calls that are coded as MH related

2. Someone to respond: Number of communities that have mobile behavioral health crisis 

capacity 

a. Independent of first responder structures (police, paramedic, fire)

b. Integrated with first responder structures (police, paramedic, fire) 

c. Number that employ peers 

3. Place to Go:

a. Number of Emergency Departments 

b. Number of Emergency Departments that operate a specialized behavior health 

component 

c. Number of Crisis Receiving and Stabilization Centers (short term, 23 hour units 

that can diagnose and stabilize individuals in crisis) 
93

• Based on SAMHSA’s National Guidelines for Behavioral Health Crisis Care, explain 

how the state will develop the crisis system. 

 

• Briefly describe the proposed/planned activities utilizing the 5 percent set aside.

16. Recovery – Required

The performance of recovery supports and services are essential for providing comprehensive, 

quality M/SUD care. The expansion in access to; and coverage for, health care drives SAMHSA 

to promote the availability, quality, and financing of vital services and support systems that 

facilitate recovery for individuals. Recovery encompasses the spectrum of individual needs 

related to those with M/SUD. 

Recovery is supported through the key components of: health (access to quality health and 

M/SUD treatment); home (housing with needed supports), purpose (education, employment, and 

other pursuits); and community (peer, family, and other social supports). The principles of a 

recovery guided approach to person-centered care is inclusive of shared decision-making, 

culturally welcoming, and sensitive to social determinants of health. The continuum of care for 

these conditions involves psychiatric and psychosocial interventions to address acute episodes or 

recurrence of symptoms associated with an individual’s M/SUD. Because mental and substance 

use disorders can become chronic relapsing conditions, long term systems and services are

necessary to facilitate the initiation, stabilization, and management of recovery and personal 

success over the lifespan.

SAMHSA has developed the following working definition of recovery from mental and/or

substance use disorders: 

Recovery is a process of change through which individuals improve their health and wellness,

live a self-directed life to the greatest extent possible, and strive to reach their full potential.

In addition, SAMHSA identified 10 guiding principles of recovery: 

• Recovery emerges from hope;

• Recovery is person-driven; 

• Recovery occurs via many pathways; 

• Recovery is holistic;
94

• Recovery is supported by peers and allies;

• Recovery is supported through relationship and social networks; 

• Recovery is culturally-based and influenced; 

• Recovery is supported by addressing trauma;

• Recovery involves individuals, families, community strengths, and

responsibility; 

• Recovery is based on respect.

Please see SAMHSA’s Working Definition of Recovery from Mental Disorders and Substance

Use Disorders. 

States are strongly encouraged to consider ways to incorporate recovery support services, 

including peer-delivered services, into their continuum of care. Technical assistance and training

on a variety of such services are available through the SAMHSA supported National Technical 

Assistance and Training Centers. SAMHSA strongly encourages states to take proactive steps to

implement and expand recovery support services. 

Because recovery is based on the involvement of consumers/peers/people in recovery, their 

family members, and caregivers, SMHAs and SSAs can engage these individuals, families, and

caregivers in developing recovery-oriented systems and services. States should also support 

existing organizations and direct resources for enhancing consumer, family, and youth networks; 

recovery community organizations and peer-run organizations; and advocacy organizations to 

ensure a recovery orientation and expand support networks and recovery services. States are 

strongly encouraged to engage individuals and families in developing, implementing, and 

monitoring the state M/SUD treatment system. 

1. Does the state support recovery through any of the following: 

a) Training/education on recovery principles and recovery-oriented 

practice and systems, including the role of peers in care? 

Yes No

b) Required peer accreditation or certification?

Yes No

c) Use block grant funding for recovery support services?

 Yes No

d) Involvement of persons in recovery/peers/family members in

planning, implementation,or evaluation of the impact of the 

state’s M/SUD system?

Yes No

2. Does the state measure the impact of your consumer and recovery 

community outreach activity?

Yes No
95

3. Provide a description of recovery and recovery support services for

adults with SMI and children with SED in your state. 

4. Provide a description of recovery and recovery support 

services for individuals with SUD in your state. 

5. Does the state have any activities that it would like to highlight? 

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

17. Community Living and the Implementation of Olmstead- Requested

The integration mandate in Title II of the Americans with Disabilities Act (ADA) and the 

Supreme Court’s decision in Olmstead v. L.C., 527 U.S. 581 (1999), provide legal 

requirements that are consistent with SAMHSA’s mission to reduce the impact of M/SUD on 

America’s communities. Being an active member of a community is an important part of 

recovery for persons with M/SUD conditions. Title II of the ADA and the regulations 

promulgated for its enforcement require that states provide services in the most integrated 

setting appropriate to the individual and prohibit needless institutionalization and segregation in 

work, living, and other settings. In response to the 10th anniversary of the Supreme Court’s 

Olmstead decision, the Coordinating Council on Community Living was created at HHS. 
96

SAMHSA has been a key member of the council and has funded a number of technical 

assistance opportunities to promote integrated services for people with M/SUD needs, including 

a policy academy to share effective practices with states.

Community living has been a priority across the federal government with recent changes to 

section 811 and other housing programs operated by the Department of Housing and Urban 

Development (HUD). HUD and HHS collaborate to support housing opportunities for persons 

with disabilities, including persons with behavioral illnesses. The Department of Justice (DOJ) 

and the HHS Office for Civil Rights (OCR) cooperate on enforcement and compliance 

measures. DOJ and OCR have expressed concern about some aspects of state mental health 

systems including use of traditional institutions and other settings that have institutional 

characteristics to serve persons whose needs could be better met in community settings. More

recently, there has been litigation regarding certain evidenced-based supported employment 

services such as sheltered workshops. States should ensure block grant funds are allocated to 

support prevention, treatment, and recovery services in community settings whenever feasible 

and remain committed, as SAMHSA is, to ensuring services are implemented in accordance 

with Olmstead and Title II of the ADA.

It is requested that the state submit their Olmstead Plan as a part of this application, or address 

the following when describing community living and implementation of Olmstead:

1. Does the state’s Olmstead plan include: 

Housing services provided Yes No

Home and community-based services Yes No

Peer support services Yes No

Employment services Yes No

2. Does the state have a plan to transition individuals from hospitals to community settings?

 Yes No

3. What efforts are occurring in the state or being planned to address the ADA community 

integration mandate required by the Olmstead Decision of 1999? 

Please indicate areas of technical assistance needed related to this section. 
97

18. Children and Adolescents M/SUD Services –Required for MHBG, Requested for SABG

MHBG funds are intended to support programs and activities for children and adolescents with 

SED, and SABG funds are available for prevention, treatment, and recovery services for youth 

and young adults with SUD. Each year, an estimated 20 percent of children in the U.S. have a 

diagnosable mental health condition and one in 10 suffers from a serious emotional disturbance 

that contributes to substantial impairment in their functioning at home, at school, or in the 

community.41 Most mental disorders have their roots in childhood, with about 50 percent of 

affected adults manifesting such disorders by age 14, and 75 percent by age 24.42 For youth 

between the ages of 10 and 24, suicide is the third leading cause of death and for children 

between 12 and 17, the second leading cause of death.43 

Data show that 11 percent of high school students have a diagnosable SUD involving nicotine, 

alcohol, or illicit drugs, and nine out of 10 adults who meet clinical criteria for a substance use 

disorder started smoking, drinking, or using illicit drugs before the age of 18. Of people who 

started using before the age of 18, one in four will develop an addiction compared to one in 

twenty-five who started using substances after age 21.44 Mental and substance use disorders in 

children and adolescents are complex, typically involving multiple challenges. These children 

and youth are frequently involved in more than one specialized system, including mental 

health, substance abuse, primary health, education, childcare, child welfare, or juvenile justice. 

This multi-system involvement often results in fragmented and inadequate care, leaving 

families overwhelmed and children’s needs unmet. For youth and young adults who are 

transitioning into adult responsibilities, negotiating between the child- and adult-serving 

systems becomes even harder. To address the need for additional coordination, SAMHSA is 

encouraging states to designate a point person for children to assist schools in assuring 

identified children are connected with available mental health and/or substance abuse 

screening, treatment, and recovery support services.

Since 1993, SAMHSA has funded the Children’s Mental Health Initiative (CMHI) to build the 

system of care approach in states and communities around the country. This has been an 

ongoing program with 173 grants awarded to states and communities, and every state has 

received at least one CMHI grant. Since then SAMHSA has awarded planning and 

implementation grants to states for adolescent and transition age youth SUD treatment and 

infrastructure development. This work has included a focus on financing, workforce 

development and implementing evidence-based treatments. 

For the past 25 years, the system of care approach has been the major framework for improving 

41 Centers for Disease Control and Prevention, (2013). Mental Health Surveillance among Children — United States, 2005-2011. 

MMWR 62(2).

42 Kessler, R.C., Berglund, P., Demler, O., Jin, R., Merikangas, K.R., & Walters, E.E. (2005). Lifetime prevalence and age-ofonset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 

593–602. 43 Centers for Disease Control and Prevention. (2010). National Center for Injury Prevention and Control. Web-based Injury 

Statistics Query and Reporting System (WISQARS) [online]. (2010). Available from www.cdc.gov/injury/wisqars/index.html. 44 The National Center on Addiction and Substance Abuse at Columbia University. (June 2011). Adolescent Substance Abuse: 

America’s #1 Public Health Problem.
98

delivery systems, services, and outcomes for children, youth, and young adults with mental 

and/or SUD and co-occurring M/SUD and their families. This approach is comprised of a 

spectrum of effective, community-based services and supports that are organized into a 

coordinated network. This approach helps build meaningful partnerships across systems and 

addresses cultural and linguistic needs while improving the child, youth and young adult 

functioning in home, school, and community. The system of care approach provides 

individualized services, is family driven; youth guided and culturally competent; and builds on 

the strengths of the child, youth or young adult and their family to promote recovery and 

resilience. Services are delivered in the least restrictive environment possible, use evidencebased practices, and create effective cross-system collaboration including integrated 

management of service delivery and costs.45

According to data from the 2015 Report to Congress46 on systems of care, services: 

1 reach many children and youth typically underserved by the mental health system. 

2 improve emotional and behavioral outcomes for children and youth. 

3 enhance family outcomes, such as decreased caregiver stress. 

4 decrease suicidal ideation and gestures.

5 expand the availability of effective supports and services; and 

6 save money by reducing costs in high cost services such as residential settings, 

inpatient hospitals, and juvenile justice settings.

SAMHSA expects that states will build on the well-documented, effective system of care 

approach to serving children and youth with serious M/SUD needs. Given the multi-system 

involvement of these children and youth, the system of care approach provides the infrastructure 

to improve care coordination and outcomes, manage costs, and better invest resources. The 

array of services and supports in the system of care approach includes: 

• non-residential services (e.g., wraparound service planning, intensive case management, 

outpatient therapy, intensive home-based services, SUD intensive outpatient services, 

continuing care, and mobile crisis response); 

• supportive services, (e.g., peer youth support, family peer support, respite services, 

mental health consultation, and supported education and employment); and 

• residential services (e.g., therapeutic foster care, crisis stabilization services, and 

inpatient medical detoxification). 

Please respond to the following:

1. Does the state utilize a system of care approach to support: 

a) The recovery and resilience of children and youth with SED? 

Yes No

45 Department of Mental Health Services. (2011) The Comprehensive Community Mental Health Services for Children and 

Their Families Program: Evaluation Findings. Annual Report to Congress. Available from 

https://store.samhsa.gov/product/Comprehensive-Community-Mental-Health-Services-for-Children-and-Their-FamiliesProgram-Evaluation-Findings-Executive-Summary/PEP12-CMHI0608SUM 46 http://www.samhsa.gov/sites/default/files/programs_campaigns/nitt-ta/2015-report-to-congress.pdf
99

b) The recovery and resilience of children and youth with SUD? 

Yes No

2. Does the state have an established collaboration plan to work with other child- and youthserving agencies in the state to address M/SUD needs 

a) Child welfare? 

Yes No

b) Juvenile justice? 

Yes No

c) Education? 

Yes No

3. Does the state monitor its progress and effectiveness, around: 

a) Service utilization? 

Yes No

b) Costs? 

Yes No

c) Outcomes for children and youth services? 

Yes No

4. Does the state provide training in evidence-based : 

a) Substance misuse prevention, SUD treatment and recovery services for 

children/adolescents, and their families?

 Yes No

b) Mental health treatment and recovery services for children/adolescents and their families? 

 Yes No

5. Does the state have plans for transitioning children and youth receiving services: 

a) to the adult M/SUD system? 

 Yes No

b) for youth in foster care? 

 Yes No

6. Describe how the state provide integrated services through the system of care (social 

services, educational services, child welfare services, juvenile justice services, law 

enforcement services, substance use disorders, etc.) 

7. Does the state have any activities related to this section that you would like to highlight?
100

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

 

19. Suicide Prevention – (Required for MHBG)

Suicide is a major public health concern, it is the 10th leading cause of death overall, with over 

40,000 people dying by suicide each year in the United States. The causes of suicide are 

complex and determined by multiple combinations of factors, such as mental illness, substance 

abuse, painful losses, exposure to violence, and social isolation. Mental illness and substance 

abuse are possible factors in 90 percent of the deaths from suicide, and alcohol use is a factor in 

approximately one-third of all suicides. Therefore, SAMHSA urges M/SUD agencies to lead in 

ways that are suitable to this growing area of concern. SAMHSA is committed to supporting 

states and territories in providing services to individuals with SMI/SED who are at risk for 

suicide using MHBG funds to address these risk factors and prevent suicide. SAMHSA 

encourages the M/SUD agencies play a leadership role on suicide prevention efforts, including 

shaping, implementing, monitoring, care, and recovery support services among individuals with 

SMI/SED.

Please respond to the following: 

1. Have you updated your state’s suicide prevention plan in the last 2 years?

Yes No

2. Describe activities intended to reduce incidents of suicide in your state. 

3. Have you incorporated any strategies supportive of Zero Suicide? 

Yes No

4. Do you have any initiatives focused on improving care transitions for suicidal patients 

being discharged from inpatient units or emergency departments? 

Yes No
101

5. Have you begun any targeted or statewide initiatives since the FFY 2020 - 2021 plan was 

submitted?

Yes No

If so, please describe the population targeted? 

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

20. Support of State Partners - Required for MHBG

The success of a state’s MHBG and SABG programs will rely heavily on the strategic 

partnership that SMHAs and SSAs have or will develop with other health, social services, and 

education providers, as well as other state, local, and tribal governmental entities. Examples of 

partnerships may include: 

 

• The SMA agreeing to consult with the SMHA or the SSA in the development and/or 

oversight of health homes for individuals with chronic health conditions or consultation 

on the benefits available to any Medicaid populations. 

• The state justice system authorities working with the state, local, and tribal judicial 

systems to develop policies and programs that address the needs of individuals with 

M/SUD who come in contact with the criminal and juvenile justice systems, promote 

strategies for appropriate diversion and alternatives to incarceration, provide screening 

and treatment, and implement transition services for those individuals reentering the 

community, including efforts focused on enrollment; 

• The state education agency examining current regulations, policies, programs, and key 

data-points in local and tribal school districts to ensure that children are safe, supported in 

their social/emotional development, exposed to initiatives that target risk and protective 

factors for M/SUD, and, for those youth with or at-risk of emotional behavioral and 

SUDs, to ensure that they have the services and supports needed to succeed in school and 

improve their graduation rates and reduce out-of-district placements; 

• The state child welfare/human services department, in response to state child and family 

services reviews, working with local and tribal child welfare agencies to address the 

trauma and mental and substance use disorders in children, youth, and family members 
102

that often put children and youth at-risk for maltreatment and subsequent out-of-home 

placement and involvement with the foster care system, including specific service issues, 

such as the appropriate use of psychotropic medication for children and youth involved in 

child welfare; 

• The state public housing agencies which can be critical for the implementation of 

Olmstead.

• The state public health authority that provides epidemiology data and/or provides or leads 

prevention services and activities; and 

• The state’s office of homeland security/emergency management agency and other 

partners actively collaborate with the SMHA/SSA in planning for emergencies that may 

result in M/SUD needs and/or impact persons with M/SUD conditions and their families 

and caregivers, providers of M/SUD services, and the state’s ability to provide M/SUD

services to meet all phases of an emergency (mitigation, preparedness, response and 

recovery) and including appropriate engagement of volunteers with expertise and interest 

in M/SUD. 

Please respond to the following items:

1. Has your state added any new partners or partnerships since the last planning period? 

Yes No

2. Has your state identified the need to develop new partnerships that you did not have in place? 

 

Yes No

If yes, with whom? 

3. Describe the manner in which your state and local entities will coordinate services to 

maximize the efficiency, effectiveness, quality and cost-effectiveness of services and 

programs to produce the best possible outcomes with other agencies to enable consumers to 

function outside of inpatient or residential institutions, including services to be provided by 

local school systems under the Individuals with Disabilities Education Act. 
103

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

21. State Planning/Advisory Council and Input on the Mental Health/Substance Abuse 

Block Grant Application- Required for MHBG

Each state is required to establish and maintain a state Mental Health Planning/Advisory 

Council to carry out the statutory functions as described in 42 U.S. C. 300x-3 for adults with 

SMI and children with SED. To meet the needs of states that are integrating services supported 

by MHBG and SABG, SAMHSA is recommending that states expand their Mental Health 

Advisory Council to include substance misuse prevention, SUD treatment, and recovery 

representation, referred to here as an Advisory/Planning Council (PC). SAMHSA encourages 

states to expand their required Council’s comprehensive approach by designing and 

implementing regularly scheduled collaborations with an existing substance misuse prevention, 

treatment, and recovery advisory council to ensure that the council reviews issues and services 

for persons with, or at risk, for substance misuse and SUDs. To assist with implementing a PC, 

SAMHSA has created Best Practices for State Behavioral Health Planning Councils: The Road 

to Planning Council Integration.

47 

Planning Councils are required by statute to review state plans and implementation reports; and 

submit any recommended modifications to the state. Planning councils monitor, review, and 

evaluate, not less than once each year, the allocation and adequacy of mental health services 

within the state. They also serve as an advocate for individuals with M/SUD problems. 

SAMHSA requests that any recommendations for modifications to the application or comments 

to the implementation report that were received from the Planning Council be submitted to 

SAMHSA, regardless of whether the state has accepted the recommendations. The 

documentation, preferably a letter signed by the Chair of the Planning Council, should state that 

the Planning Council reviewed the application and implementation report and should be 

transmitted as attachments by the state.

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

system:

47 https://www.samhsa.gov/sites/default/files/manual-planning-council-best-practices-2014.pdf
104

1. How was the Council involved in the development and review of the state plan and report? 

Attach supporting documentation (e.g., meeting minutes, letters of support, etc.)

a) What mechanism does the state use to plan and implement substance misuse prevention, 

treatment, and recovery services?

b) Has the Council successfully integrated substance misuse prevention and treatment or 

co-occurring disorder issues, concerns, and activities into its work? 

 Yes No

2. Is the membership representative of the service area population (e.g., ethnic, cultural,

linguistic, rural, suburban, urban, older adults, families of young children)? 

 Yes No 

3. Please describe the duties and responsibilities of the Council, including how it gathers 

meaningful input from people in recovery, families, and other important stakeholders, and 

how it has advocated for individuals with SMI or SED. 

Additionally, please complete the Advisory Council Members and Behavioral Health Advisory 

Council Composition by Member Type forms.48

48 There are strict state Council membership guidelines. States must demonstrate: (1) the involvement of people in recovery and their family 

members; (2) the ratio of parents of children with SED to other Council members is sufficient to provide adequate representation of that 

constituency in deliberations on the Council; and (3) no less than 50 percent of the members of the Council are individuals who are not state

employees or providers of mental health services. 
105

 Advisory Council Members

Name Type of 

Membership*

Agency or 

Organization

Represented*

Address 

Phone & 

Fax

Email 

Address

(If 

Available) 

**State Mental 

Health Agency

**State 

Education 

Agency

**State 

Vocational 

Rehabilitation 

Agency

**State Criminal 

Justice Agency 

**State Housing 

Agency 

**State Social 

Services Agency 

***State

Medicaid 

Agency 

***State 

Marketplace 

Agency 

***State Child 

Welfare Agency 

***State Health 

Agency 

***State Agency 

on Aging 

*Council members should be listed only once by type of membership and Agency/organization represented. 

** Required by Statute. 

***Requested not required
106

Advisory Council Composition by Member Type 

Type of Membership

Number

Percentage 

of Total

Membership

Total Membership

Individuals in Recovery* (to include adults with SMI who 

are receiving, or have received, mental health services) 

Family Members of Individuals in Recovery* (to 

include family members of adults with SMI)

Parents of children with SED/SUD* 

Vacancies (individual & family members)

Others (Advocates who are not State employees or

providers) 

Total Individuals in Recovery, Family Members and 

Others

State Employees

Providers

Vacancies

TOTAL State Employees & Providers

Individuals/Family Members from Diverse Racial, Ethnic, 

and LGBTQ+ Populations

Providers from Diverse Racial, Ethnic, and LGBTQ+

Populations

TOTAL Individuals and Providers from Diverse

Racial, Ethnic, and LGBTQ+ Populations

Persons in recovery from or providing treatment for

or advocating for SUD services

Representatives from Federally Recognized Tribes 

Youth/adolescent representative (or member from an 

organization serving young people).

*States are encouraged to select these representatives from state Family/Consumer organizations or 

include individuals with substance misuse prevention, SUD treatment, and recovery expertise in their 

Councils.
107

22. Public Comment on the State Plan- Required

Title XIX, Subpart III, section 1941 of the PHS Act (42 U.S.C. § 300x-51) requires, as a 

condition of the funding agreement for the grant, states to provide an opportunity for the 

public to comment on the state block grant plan. States should make the plan public in such 

a manner as to facilitate comment from any person (including federal, tribal, or other public 

agencies) both during the development of the plan (including any revisions) and after the 

submission of the plan to SAMHSA.

1. Did the state take any of the following steps to make the public aware of the plan and 

allow for public comment?

a) Public meetings or hearings? 

Yes No

b) Posting of the plan on the web for public comment? 

Yes No

If yes, provide URL: 

If yes for the previous plan year, was the final version posted for the previous year? 

Please provide that URL:

c) Other (e.g., public service announcements, print media) 

Yes No
108

Acronyms

ACF Administration for Children and Families 

ACL Administration for Community Living 

ACO Accountable Care Organization

ACT Assertive Community Treatment

AHRQ Agency for Healthcare Research and Quality 

AI American Indian

AIDS Acquired Immune Deficiency Syndrome 

AN Alaskan Native

ARP American Rescue Plan

AOT Assisted Outpatient Treatment

ATOD Alcohol, Tobacco and Other Drugs

BHSIS Behavioral Health Services Information System 

CAP Consumer Assistance Programs

CBHSQ Center for Behavioral Health Statistics and Quality 

CCBHC Certified Community Behavioral Health Center

CFR Code of Federal Regulations 

CHC Community Health Center 

CHIP Children’s Health Insurance Program 

CLAS Culturally and Linguistically Appropriate Services 

CMHC Community Mental Health Center 

CMS Centers for Medicare and Medicaid Services 

COVID-19 Coronavirus Disease of 2019 

CPT Current Procedural Terminology 

CSC Coordinated Specialty Care 

DSM-V Diagnostic and Statistical Manual of Mental Disorders, Fifth 

Edition

EBP Evidence-Based Practice

EHB Essential Health Benefit

EHR Electronic Health Record 

EIS Early Intervention Services (association with Human 
109

Immunodeficiency Virus (HIV)

ESMI Early Serious Mental Illness

FFY Federal Fiscal Year 

FMAP Federal Medical Assistance Percentage 

FPL Federal Poverty Level

FQHC Federally-Qualified Health Center 

HCPCS Healthcare Common Procedure Coding System 

HHS Department of Health and Human Services 

HIE Health Information Exchange 

HIT Health Information Technology 

HIV Human Immunodeficiency Virus (associated with Early 

Intervention Services) 

HRSA Health Resources and Services Administration

ICD-10 The International Statistical Classification of Diseases and Related Health

 Problems, 10th Revision

ICT Interactive Communication Technology 

IDU Intravenous Drug User 

IMD Institutions for Mental Diseases 

KIT Knowledge Information Transformation (associated with 

EBP implementation)

MAT Medication Assisted Treatment

MCO Managed Care Organization 

MHBG Community Mental Health Services Block Grant 

MHPAEA Mental Health Parity and Addiction Equity Act 

MOE Maintenance of Effort

M/SUD Mental and/or Substance Use Disorder 

NAS National Academies of Science

NBHQF National Behavioral Health Quality Framework 

NHAS National HIV/AIDS Strategy 

NIAAA National Institute on Alcoholism and Alcohol Abuse 

NIDA National Institute on Drug Abuse 

NIMH National Institute on Mental Health
110

NOMS National Outcome Measures

NQF National Quality Forum

NQS National Quality Strategy 

OCR Office for Civil Rights 

OMB Office of Management and Budget

PBHCI Primary and Behavioral Health Care Integration 

PBR Patient Bill of Rights 

PCP Person Centered Planning 

PHS Public Health Service

PPW Pregnant and Parenting Women

PPWC Pregnant and Postpartum Women and Children 

PWWDC Pregnant Women and Women with Dependent Children 

PWID Persons Who Inject Drugs

QHP Qualified Health Plan 

RAISE Recovery After an Initial Schizophrenia Episode 

RCO Recovery Community Organization 

RFP Request for Proposal 

SABG Substance Abuse Prevention and Treatment Block Grant 

SAMHSA Substance Abuse and Mental Health Services Administration

SBIRT Screening, Brief Intervention, and Referral to Treatment 

SED Serious Emotional Disturbance 

SFY State fiscal year

SEOW State Epidemiological Outcome Workgroup 

SMHA State Mental Health Authority 

SMI Serious Mental Illness 

SPA State Plan Amendment

SPF Strategic Prevention Framework 

SSA Single State Agency

SUD Substance Use Disorder

TIP Treatment Improvement Protocol 

TLOA Tribal Law and Order Act 
111

U.S.C. United States Code

VA U.S. Department of Veterans Affairs
112

Resources

TOPIC LINK DESCRIPTION

SAMHSA Block Grants http://samhsa.gov/grants/block-grants

Description of Block Grant, its purpose, deadlines, laws and regulations 

and resources

SAMHSA Topic Search http://www.samhsa.gov/topics

Search SAMHSA's website for resources, information and updates by 

topic or program

SAMHSA Store http://store.samhsa.gov/ Search SAMHSA’s store to download or order publications and resources

RESOURCES IN ALPHABETICAL ORDER BY TOPIC/TITLE

TOPIC LINK DESCRIPTION

21st Century Cures Act

https://www.congress.gov/114/bills/hr34/BILLS114hr34enr.pdfLink to the 21st Century Cures Act, which includes the section on Helping 

Families in Mental Health Crisis Reform Act of 2016

Center for Integrated Health 

Solutions http://www.integration.samhsa.gov/

HRSA-SAMHSA Center for Integrated Health Solutions offers resources, 

trainings, hot topics, and webinars on primary and behavioral health care 

integration

Characteristics of State Mental 

Health Agency Data Systems

http://store.samhsa.gov/product/Characteristics-ofState-Mental-Health-Agency-Data-Systems/SMA08-4361

Reviews current information technology (IT) systems and technology 

implementation efforts in state mental health agencies. Reports key 

findings on IT and structure, client-level and claims-level data, linking to 

other state data, and electronic health records. (Downloadable report)

Children Mental Health 

https://store.samhsa.gov/product/ComprehensiveCommunity-Mental-Health-Services-for-Children-andTheir-Families-Program-Evaluation-Findings-ExecutiveSummary/PEP12-CMHI0608SUMPresents program evaluation findings of a federally funded initiative that 

supports systems of care for community-based mental health services for 

children, youth, and their families. Reports on FFY2010 data that track 

service characteristics, use, and outcomes. (Downloadable report)
113

TOPIC LINK DESCRIPTION

Co-Occurring Resources and 

Models http://www.samhsa.gov/co-occurring/

SAMHSA's webpage dedicated to co-occurring models and practice. 

Includes: resources, webinars, public resource links and more.

Health Care Integration 

https://www.samhsa.gov/grants/grantannouncements/sm-15-005 Overview of SAMHSA Health Care Integration initiatives and links to 

resources and information about health care integration

Health Homes

http://www.integration.samhsa.gov/integrated-caremodels/health-homesSAMHSA's description of Health Homes and resources around health 

homes

Healthy People Initiative http://www.healthypeople.gov/2020/default.aspx

Government website that reviews the goals of Healthy People 2020 and 

provides resources to help meet the goals. 

Health Financing

https://www.samhsa.gov/homelessness-programsresources/hpr-resources/health-financing-impacthomelessness

SAMHSA guides, trainings, and technical assistance resources around 

health reform implementation.

Integrated Treatment for CoOccurring Disorders EvidenceBased Practices (EBP) KIThttps://store.samhsa.gov/product/Integrated-Treatmentfor-Co-Occurring-Disorders-Evidence-Based-PracticesEBP-KIT/SMA08-4366 

Provides practice principles about integrated treatment for co-occurring 

disorders, an approach that helps people recover by offering M/SUD 

services at the same time and in one setting. Offers suggestions from 

successful programs.

LGBTQ+ Populations

https://www.samhsa.gov/behavioral-healthequity/LGBTQ+Resources on the LGBTQ+ population include national survey reports, 

agency and federal initiatives, and related behavioral health resources.

Medicaid Policy Guidance

http://www.medicaid.gov/Federal-Policyguidance/federal-policy-guidance.html

Searchable database of Medicaid Policy Guidance’s; including peer 

support services, affordable care act, health homes, prescription drugs, 

etc.

Medication Assisted Treatment http://www.samhsa.gov/medication-assisted-treatment SAMHSA's resources, guides, and TIPs on MAT

Mental Health and Substance 

Abuse Block Grant Laws and 

Regulations

http://www.samhsa.gov/grants/block-grants/lawsregulationsLinks to the laws and regulations that govern the Mental Health and 

Substance Abuse Block Grants
114

TOPIC LINK DESCRIPTION

Mental Health Crisis

https://store.samhsa.gov/product/Core-Elements-forResponding-to-Mental-Health-Crises/SMA09-4427

Presents guidelines to improve services for people with serious mental 

illness or emotional disorders who are in mental health crises. Defines 

values, principles, and infrastructure to support appropriate responses to 

mental health crises in various situations.

National CLAS Standards http://www.ThinkCulturalHealth.hhs.gov

The National Standards for Culturally and Linguistically Appropriate 

Services in Health and Health Care (the National CLAS Standards) are 

intended to advance health equity, improve quality, and help eliminate 

health care disparities by providing a blueprint for individuals and health 

and health care organizations to implement culturally and linguistically 

appropriate services.

National HIV/AIDS Strategy 

(NHAS) for the United States 

https://www.hiv.gov/federal-response/national-hiv-aidsstrategy/nhas-update July 2010 PDF of the National HIV/AIDS Strategy for the United States

National Partnership for Action 

to End Health Disparities https://www.minorityhealth.hhs.gov/npa/ Offers an overview and resources to help end health disparities

SAMHSA’s Evidence-Based 

Practices Resource Center

https://www.samhsa.gov/resource-search/ebp

This new Evidence-Based Practices Resource Center 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. The Resource Center contains a 

collection of scientifically-based resources for a broad range of audiences, 

including Treatment Improvement Protocols, toolkits, resource guides, 

clinical practice guidelines, and other science-based resources.

National Strategy for Suicide 

Prevention

http://store.samhsa.gov/product/National-Strategy-forSuicide-Prevention-2012-Goals-and-Objectives-forAction/PEP12-NSSPGOALS

Outlines a national strategy to guide suicide prevention actions. Includes 

13 goals and 60 objectives across four strategic directions: wellness and 

empowerment; prevention services; treatment and support services; and 

surveillance, research, and evaluation. (Downloadable report)
115

TOPIC LINK DESCRIPTION

Olmstead

https://www.samhsa.gov/sites/default/files/olmstead-policy-academy.pdf

Links to the Olmstead decision document, as well as, a 

report that offers a basic primer on supportive housing, as 

well as a thorough review of states’ current Olmstead 

planning efforts in this area

Parity

https://store.samhsa.gov/sites/default/files/d7/priv/sma16-4971_print.pdf

Letter from Medicaid on Application of the Mental Health 

Parity and Addiction Equity Act to Medicaid MCOs, CHIP, 

and Alternative Benefit (Benchmark) Plans

Prevention of Underage 

Drinking http://www.ncbi.nlm.nih.gov/books/NBK44360/

The Surgeon General's Call to Action To Prevent and 

Reduce Underage Drinking seeks to engage all levels of 

government as well as individuals and private sector 

institutions and organizations in a coordinated, 

multifaceted effort to prevent and reduce underage 

drinking and its adverse consequences.

Recovery https://www.samhsa.gov/brss-tacs

SAMHSA's resources, guides, and technical assistance on 

recovery

SAMHSA.gov Data 

Resources http://www.samhsa.gov/data/

Links to SAMHSA data sets including: NSDUH, DAWN, 

NSSATS/NMHSS, TEDS, Uniform Reporting System (URS), 

National and State Barometers, etc.

SAMHSA's Evidenced 

Based Practice Knowledge 

Information 

Transformation (KIT)

http://store.samhsa.gov/product/Assertive-Community-Treatment-ACTEvidence-Based-Practices-EBP-KIT/SMA08-4345

SAMHSA’s Evidence-Based Practice Knowledge Informing 

Transformation (KIT)[1] were developed to help move the 

latest information available on effective behavioral health 

practices into community-based service delivery.

Substance Abuse for 

Women https://store.samhsa.gov/sites/default/files/d7/priv/sma13-4789.pdf

Guidance on components of quality SUD treatment 

services for women, states can refer to the documents 

found at this link

Suicide Prevention

https://www.samhsa.gov/suicide-prevention

https://www.samhsa.gov/prevention

Links to resources and guides around suicide prevention 

and other mental and substance misuse prevention topics.

Synar Program http://samhsa.gov/synar 

Description and overview of the SYNAR program, which is 

a requirement of the SABG.

Telehealth Policy Resource

https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP21-

06-02-001.pdf

Telehealth Medicaid Policy site that provides telehealth 

laws and reimbursement by state, telehealth policy PDF 

and a review of pending legislations
116

TOPIC LINK DESCRIPTION

Trauma & Violence http://www.samhsa.gov/trauma-violence

Includes information around violence and trauma, 

including the definition and review of trauma informed 

care.

Criminal & Juvenile Justice http://www.samhsa.gov/criminal-juvenile-justice

Review of behavioral health services and resources in the 

criminal justice and juvenile justice systems.

Tribal Consultation

https://obamawhitehouse.archives.gov/the-press-office/memorandumtribal-consultation-signed-presidentThe White House memorandum regarding the 

requirements related to tribal consultation