OMB No. 0930-0168 

Expiration Date: 04/30/2022 

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 186 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 2020-2021 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 

 

 

 

 

 

 

 

 

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......................................................9 

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

A. Framework for Planning—Mental Health and Substance Use Prevention and Treatment ...........12 

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

C. Environmental Factors and Plan....................................................................................................34 

1. The Health Care System, Parity and Integration - Question 1 and 2 are Required .......................34 

2. Health Disparities - Requested ......................................................................................................39 

3. Innovation in Purchasing Decisions - Requested ..........................................................................42 

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

(ESMI)-10 percent set aside - Required for MHBG .....................................................................45 

5. Person Centered Planning (PCP) –Required for MHBG ..............................................................47 

6. Program Integrity - Required...............................................................................................................48 

7. Tribes - Requested ...............................................................................................................................50 

8. Primary Prevention-Required (SABG only)........................................................................................52 

9. Statutory Criterion for MHBG (Required for MHBG) .......................................................................59 

10. Substance Use Disorder Treatment - Required for SABG .................................................................63 

11. Quality Improvement Plan- Requested ..............................................................................................72 

12. Trauma -Requested........................................................................................................................73 
 

 

 

 

 

 

 

 

 

 

 

13. Criminal and Juvenile Justice - Requested ....................................................................................75 

14. Medication Assisted Treatment – Requested (SABG only)..........................................................76 

15. Crisis Services - Requested ...........................................................................................................78 

16. Recovery - Required......................................................................................................................79 

17. Community Living and the Implementation of Olmstead- Requested..........................................82 

18. Children and Adolescents M/SUD Services –Required for MHBG, Requested for SABG .........83 

19. Suicide Prevention – (Required for MHBG).................................................................................86 

20. Support of State Partners - Required for MHBG ..........................................................................87 

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

Application- Required for MHBG.................................................................................................89 

22. Public Comment on the State Plan- required.....................................................................................94 

Acronyms ..................................................................................................................................................95 

Resources..................................................................................................................................................98 

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 
 

 

 

 

FFY 2020-2021 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.§§ 300x-300x-9) and 

sections 1921-1935 of Title XIX, Part B, Subpart II of the Public Health Service Act (42 U.S.C.§ 300x21-35), 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 timeframes; Mental and Substance Use Disorder 

(M/SUD) assessment and plan; and report requirements. These sections include discussions and 

planning around the following policy topics: health care system, parity and integration; health 

disparities; innovations in purchasing decisions; evidence-based practices for early intervention (e.g., 

serious mental illness (SMI)); person centered planning; 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 . 

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 states1 maximum flexibility to 

address the unique 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 has varied by block grant and by state. 

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

the nation’s M/SUD system is providing the highest quality and most cost effective treatment and other 

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

quality and outcomes should be carefully tracked. Ultimately, such data will lead to improvements as 

science and circumstances change. 

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

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

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

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. 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

and related policy initiatives, including the Mental Health Parity and Addiction Equity Act (MHPAEA), 

and the Tribal Law and Order Act (TLOA). The new design offered states the opportunity to complete a 

combined application for mental and substance use disorder3 (M/SUD) services, submit a biennial 

versus an annual plan4,

5 and provide information regarding their efforts to respond to various federal 

and state initiatives. The new design also reflects the increasing trend among states to integrate their 

mental health, SUD prevention, SUD treatment, and recovery administration. 

Almost two-thirds of the states took advantage of this streamlined application during FFY 2018-2019 

application process and submitted combined plans for M/SUD services. Nearly all the states provided 

specific information requested by SAMHSA regarding strategies to respond to a variety of areas 

including primary care and M/SUD integration, recovery support services, and parity implementation. 

The FFY 2020-2021 Block Grant Application furthers SAMHSA’s efforts to have states use and report 

the opportunities offered under various federal initiatives. The FFY 2020-2021Block Grant Application 

allows states to submit an 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 and substance use disorders. In addition, questions about identified needs will 

allow SAMHSA to better design technical assistance to support state efforts. 

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 decrease the prevalence and impact of mental 

and substance use disorders and/or improve the health of individuals with mental illness and addictions 

to improve how they experience care, and reduce costs. 

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.6 In response to the issue raised in several states of the impact of high 

deductibles on access to services, SAMHSA has released guidance to the states on these issues. 

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 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 

3 The term “substance use disorder” means substance-related and addictive disorder as described in the Diagnostic and 

Statistical Manual of Mental Disorders, Fifth Edition, Arlington, VA, American Psychiatric Association. 

4 State Plan for Comprehensive Community Mental Health Services for Certain Individuals (Sec. 1912 of Title XIX, Part B, Subpart I of the 

Public Health Service (PHS) Act (42 USC § 300x-2) 

https://www.gpo.gov/fdsys/pkg/USCODE-2010-title42/pdf/USCODE-2010-title42-chap6A-subchapXVIIpartB.pdf 

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

 

 

 

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 think more broadly about their impact on special populations that they have historically served 

through federal block grants and other funding. 

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

that may be addressed. These populations include military families, youth who need mental and 

substance use disorder 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 take into 

account culturally specific services for racial and ethnic minorities. Services should also address the 

unique needs of tribal populations and the role of tribal governments in planning and delivering services. 

The use of technologies may support better access to services, especially those more likely to be 

comfortable with these new technologies. Advances in technology have changed significantly since 

SAMHSA’s inception in 1992. Technology is playing a growing 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. 

The Health Information Technology for Economic and Clinical Health (HITECH) Act place strong 

emphasis on the widespread adoption and implementation of EHR technology. Accordingly, all 
 

 

SAMHSA grantees that provide services to individuals are encouraged to demonstrate ongoing clinical 

use of a certified EHR system. A certified EHR is an electronic health record 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 Office of the National 

Coordinator for Health Information Technology (ONC)[1] . In addition to meeting common standards 

and certification, these systems should support the privacy and security of patient information across all 

HIT technologies. Such systems should be used to collect information on provider characteristics, client 

enrollment, demographics, and treatment. Current laws will require these systems to comply with 

national standards 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 https://www.samhsa.gov/health-information-technology (SAMHSA) and 

https://www.healthit.gov/ (ONC). 

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 reform in their states. In many respects, successful 

implementation is dependent on leadership and collaboration among multiple stakeholders. The 

relationships among the SMHAs, SSAs, and the state Medicaid directors, insurance commissioners, 

prevention agencies, child-serving agencies, education authorities, justice authorities, public health 

authorities, and 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. 

On October 18, 2016, the Office of the Assistant Secretary for Health (OASH) released its report, Public 

Health 3.0: A Call to Action to Create a 21st Century Public Health Infrastructure. Public Health 3.0 

(PH3) is a significant upgrade in public health practice to a modern version that emphasizes crosssectorial environmental, policy- and systems- level actions that directly affect the social determinants of 

health. SAMHSA and OASH are encouraging all public health authorities to adopt Public Health 

Accreditation Board (PHAB) criteria. Further, public health department accreditation should be 

enhanced and supported to best foster Public Health 3.0 principles, as we strive to ensure that every 

person in the United States is served by nationally accredited health departments 

State authorities focus their system goals on recovery. 

People can and do recover from mental and substance use disorders, and services and supports must 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

foster 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. 

State authorities continue to monitor the coverage of M/SUD services offered by 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 continue to make primary substance use disorder prevention a priority. 

To respond to the primary prevention set-aside requirement of the SABG, states should keep in mind 

that the backbone of a prevention system is an infrastructure with the ability to collect and analyze 

epidemiological data on substance use and its associated consequences. The system must also be able to 

use this data to identify areas of greatest need, and to identify, implement, and evaluate evidence-based 

programs, practices, and policies that have the ability to reduce substance use and improve health and 

well-being in all communities. 

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

States need to make the most efficient use of funds for 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 datadriven 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 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. In addition to this tool, SAMHSA has 

been working with states and state representative organizations to identify and implement a core set of 

measures, which include approved quality measures to assess outcomes and quality in programming. 

This effort has sought to both guide and align the measurement requirements of other major service 

purchasers, such as Medicaid and Medicare, and thus facilitate efficiencies in state reporting of 

behavioral health quality measures to federal entities. It is anticipated that once implemented, states will 

develop an implementation plan – both general to all states and unique to their particular state –

regarding the specifics and realities of how these measures are being collected and reported, as well as 

how this effort is being coordinated with required reporting activities from Medicaid, Medicare, and 

other public payers. 

States authorities monitor implementation status and activities under the federal parity law to ensure 

that individuals with M/SUD conditions are receiving the mandated coverage and access. 

Plans and issuers subject to MHPAEA7 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 components of the essential 

health benefits package required by the Affordable Care Act that are offered. 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 

7 http://www.samhsa.gov/health-financing/implementation-mental-health-parity-addiction-equity-act 
 

 

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 

a behavioral health condition. 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 to take 

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

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

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

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

improving health equity8. 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 are encouraged to implement, track, and monitor recovery-oriented, quality mental and 

substance use disorder services. 

The four dimensions of recovery: 

1. Health: overcoming or managing one’s disease(s) or symptoms — for example, 

abstaining from use of alcohol, illicit drugs, and non-prescribed medications if one has an 

addiction problem — and for everyone in recovery making informed and healthy choices 

that support physical and emotional wellbeing. 

• Promote treatment, health and recovery-support services for individuals with mental 

and/or substance use disorders. 

• Promote health, wellness, and resiliency. 

• Promote recovery-oriented service systems. 

• Engage individuals in recovery and their families in self-directed care, shared 

decision-making and person-centered planning. 

2. Home: a stable and safe place to live. 

8 http://www.samhsa.gov/behavioral-health-equity 
• Ensure that supported independent housing and recovery housing are available for 

individuals with mental and/or substance use disorders. 

• Improve access to mainstream benefits, housing assistance programs, and supportive 

services for people with mental and/or substance use disorders. 

• Build leadership, promote collaborations, and support the use of evidence-based 

practices related to permanent supportive housing and recovery housing. 

• Increase knowledge of the M/SUD field about housing and homelessness among 

people with mental and/or substance use disorders. 

3. Purpose: meaningful daily activities, such as a job, school, volunteerism, family 

caretaking, or creative endeavors, and the independence, income, and resources to 

participate in society. 

• Increase gainful employment and educational opportunities for individuals with or in 

recovery from mental and/or substance use disorders. 

• Increase the proportion of individuals with mental and/or substance use disorders who 

are gainfully employed and/or participating in self-directed educational endeavors. 

• Develop employer strategies to address national employment and education 

disparities among people with identified M/SUD problems. 

• Implement evidence-based practices related to employment and education for 

individuals with mental and/or substance use disorders. 

4. Community: relationships and social networks that provide support, friendship, love, 

and hope. 

• Promote peer support and the social inclusion of individuals with or in recovery from 

mental and/or substance use disorders in the community. 

• Increase the number and quality of consumer/peer recovery support specialists 

and consumer-operated/peer run recovery support service provider organizations. 

• Promote the social inclusion of people with mental and/or substance use disorders. 

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 in their states 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 needed and 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 without insurance or for whom 

coverage is terminated for short periods of time; 

2. To fund those priority treatment and support services not covered by Children’s Health 

Insurance Program (CHIP) , Medicaid, Medicare, or private insurance for low-income 

individuals and that demonstrate success in improving outcomes and/or supporting recovery; 

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

activities and services for persons not identified as needing SUD treatment; and 

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

ongoing effectiveness of promotion/SUD prevention, treatment and recovery supports and to plan 

the implementation of new services. 

II. SUBMISSION OF APPLICATION AND PLAN TIMEFRAMES 

Statutory Deadlines 

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

states to turn in their Application as early as possible to allow for a full discussion and review by 

SAMHSA. Applications for the MHBG are due no later than September 3, 2019. Applications for 

SABG are due no later than October 1, 2019. Single Applications for MHBG and SABG are due no later 

than September 3, 2019. MHBG and SABG Reports are due December 1, 2019. In addition, for the 

SABG, the Annual Synar Report is due no later than December 31, 2019. 

The FFY 2020-2021 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 2020-

2021. States will have the option, but will not be required to amend their Plans when they submit their 

FFY 2021 Application. 

States should submit their respective MHBG and SABG Application(s) for FFYs 2020 and 2021 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 2020-2021 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 2020-

2021 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 that information that is required. 

Required Sections and Tables 

The FFY 2020-2021 Application requires states to submit a M/SUD assessment and plan; expenditure, 

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

certifications. In addition, SAMHSA is requesting information on key focus areas that are critical to 

implementation of provisions related to improving the quality of life for individuals with M/SUD 

disorders. 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 and/or Table 5b (SABG Primary Prevention Planned Expenditures), 

are also required. 

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)) and MHBG funds must be used for those activities that are allowable 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 the 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 expenditure9 to plan, carry 

out, and evaluate activities and services for children with SED and adults with SMI; 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. 

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

 

 

 

10,11 

A grant may be awarded only if a state’s application(s) include(s) a State Plan 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. § 300x21) 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 report

12 in the proper format containing 

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

purposes for which 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 peersupport programs, and mental-health primary consumer-directed programs) and community mental 

health centers which meet the criteria as described in 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 substance use disorder stakeholders and use 

this mechanism to assist in the development of the state block grant plan for the SABG application. 

States must also describe the stakeholder input process for the development of both the SABG plan and 

the MHBG plan, as mandated by section 1941 of the PHS Act (42 U.S.C.§ 300x-51), which requires that 

the state block grant plans be made available to the public in such a manner as to facilitate public 

comment during the development of the plan (including any revisions) and after the submission of the 

plan to the Secretary through SAMHSA. This description should also show involvement of persons who 

are service recipients and/or in recovery, families of individuals with M/SUD, providers of services and 

10 Section 1912 of Title XIX, Part B, Subpart I of the PHS Act (42 U.S.C. § 300x-2), http://www.samhsa.gov/grants/block-grants/lawsregulations 

11Section 1932(b) of Title XIX, Part B, Subpart II of the PHS Act (42 U.S.C. § 300x-32(b)), http://www.samhsa.gov/grants/blockgrants/laws-regulations 12 Section 1942(a) of Title XIX, Part B, Subpart III of the PHS Act (42 U.S.C. § 300x-52(a)), http://www.samhsa.gov/grants/blockgrants/laws-regulations 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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 take into account specific populations that are the current focus of 

the block grants, the changing health care environment, and SAMHSA’s Strategic Initiatives. 

The MHBG program is designed to provide comprehensive community mental health services to 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. 

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 prevention or preventive intervention for those at risk of SMI or SED. 

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

(and certain related activities) to at-risk individuals or persons in need of SUDtreatment. 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 substance use 

disorders. 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 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 prevention 

programs, defined as programs for individuals who do not require treatment for substance use 

disorders. 

 Criterion 3: Pregnant Women and Women with Dependent Children (42 U.S.C. § 300x-22(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 § 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

substance use disorder 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 substance use disorder prevention and treatment services, performancebased accountability, data collection and reporting requirements, and any other matters that 

would serve to further improves the delivery of 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 systems of integrated 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 maintenance of effort 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) 

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 an Early Serious Mental Illness (ESMI) (10 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 

13Section 1915(b)(1) of the PHS Act (42 USC 300x-4). 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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 are in need of 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* 

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

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

 Individuals with mental and/or substance use disorders who experience homelessness or 

involved in the criminal or juvenile justice systems 

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

 Underserved racial and ethnic minority and 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 needlessly institutionalized or at risk of 

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

related issues in their planning efforts. To the extent that such data is available in a state’s Olmstead 

Plan, it should be used for block grant planning purposes. 

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 
 

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, 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. 

The description should also include how these systems address the needs of diverse racial, ethnic, and 

sexual and gender minorities, as well as American Indian/Alaskan Native populations in the states. 

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

This step should identify the unmet service needs and critical gaps in the state’s current M/SUD system 

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 M/SUD 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. 

A data-driven process must support the state’s priorities and goals. This could include data and 

information that are available through the state’s unique data system (including community-level data), as 

well as SAMHSA’s data sets including, but not limited to, the National Survey on Drug Use and Health 

(NSDUH), the Treatment Episode Data Set (TEDS), the National Facilities Surveys on Drug Abuse and 

Mental Health Services, , and the Uniform Reporting System (URS). Those states that have a State 

Epidemiological and Outcomes Workgroup (SEOW) should describe its composition and contribution to 

the process for primary prevention and treatment planning. States should also continue to use the 

prevalence formulas for adults with SMI and children with SED, as well as the prevalence estimates, 

epidemiological analyses, and profiles to establish mental health treatment, substance use disorder 

prevention, and SUD treatment goals at the state level. In addition, states should obtain and include in 

their data sources information from other state agencies that provide or purchase M/SUD services. This 

will allow states to have a more comprehensive approach to identifying the number of individuals that are 

receiving services and the types of services they are receiving. 

In addition to in-state data, SAMHSA has identified several other data sets that are available to states 

through various federal agencies: CMS, the Agency for Healthcare Research and Quality (AHRQ), and 

others. 
 

 

 

Through the Healthy People Initiative16 HHS has identified a broad set of indicators and goals to track 

and improve the nation’s health. By using the indicators included in Healthy People, states can focus 

their efforts on priority issues, support consistency in measurement, and use indicators that are being 

tracked at a national level, enabling better comparability. States should consider this resource in their 

planning. 

Step 3: Prioritize state planning activities 

Using the information in Step 2, states should identify specific priorities that will be included in the 

MHBG and SABG. The priorities must include the core federal Block Grant goals and aims of the 

MHBG and SABG programs: target populations (those that are required in legislation and regulation 

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

priorities for the plan in Plan Table 1 and indicate the priority type (i.e., substance use disorder 

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

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

For each of the priorities identified in Step 3, states should identify the relevant goals, measureable 

objectives, 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 substance use disorders. States 

should use a system of care approach that has been well established for children with SED and cooccurring substance use disorders. This approach should be used state wide, coordinating care with 

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

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

competent, individualized treatment plan. For adolescents with substance use disorders and SED, 

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

dependence. 

• 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, 

16 http://www.healthypeople.gov/2020/default.aspx 
•

 

 

 

 

 

 

 

 

 

rather than segregated programs. 

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

to engage individuals and their families into treatment and recovery supports. Almost 40 percent of 

uninsured individuals are under the age of 30 and use technology as a substantial, if not primary, 

mode of communication. 

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

permanent housing and supportive employment or education for persons with mental and 

substance use disorders). This includes how local authorities will be engaged to increase the 

availability of housing, employment, and educational opportunities, and how the state will 

develop services that will wrap around these individuals to obtain and maintain safe and 

affordable housing, employment, and/or education. 

Strategies that will 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

17 and 

The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better 

Understanding18 in developing this strategy. 

• Strategies that will build the state and provider capacity to provide evidence-based, trauma-specific 

interventions in the context of a trauma-informed delivery system. Recognizing trauma as a critical 

factor in the development of mental and substance use disorders, states should build provider 

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

provided in systems that understand the impact of trauma on their service population and work to 

eliminate organizational practices and policies that may cause new or exacerbate existing trauma. 

SAMHSA has developed “SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed 

Approach” to provide states with a framework for incorporation of trauma informed care into its 

system. 

• Strategies that increase the use of person-centered planning, self-direction, and participant-directed 

care. This includes measures to help individuals or caregivers (when appropriate) identify and 

access services and supports that reinforce recovery or resilience. These strategies should also 

include how individuals or caregivers have access to supports to facilitate participant direction, 

including the ability to manage a flexible budget to address recovery goals; identifying, selecting hiring 

and managing support workers and providers; and ability to purchase goods and services identified in the 

recovery or resilience planning process. 

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

17 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 18 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. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

and practices in their prevention efforts that include: 

• Information dissemination; 

• Education; 

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

• Problem identification and referral; 

• Community based programming; and, 

• Environmental strategies that establish or change written and unwritten community standards, 

codes, and attitudes, thereby influencing incidence and prevalence of the abuse of alcohol, 

tobacco, and other drugs used in the general population 

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

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

Reduce Underage Drinking19 ,Evidence Based Practices Resource Center and/or other materials 

documenting their effectiveness. These strategies include: 

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

research and encompass a range of activities including policy initiatives and programs; 

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

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

the problems, and enhance resiliency. 

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

misuse 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 

19 http://store.samhsa.gov/product/Surgeon-General-s-Call-to-Action-to-Prevent-and-Reduce-Underage-Drinking/SGCTA-07 
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 mental and substance use disorders in the planning and delivery of services. 

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

administrative service organizations (including 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 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 mental and 

substance use disorders. 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 2020 and how the state proposes to 

measure the change in FFY 2021. States must use the template (Plan Table 1: Priority Areas by Goal, 

Strategy, and Performance Indicators) below. 

Plan Table #1. Priority Area and Annual Performance Indicators 

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

Substance 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 Web BGAS: 

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

completed for the first priority area, another table will appear so additional priorities can be 

added. 

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

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

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

general description of what the state hopes to accomplish. 

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

6. Strategies to attain the objective. Indicate state 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 2020); 

c) Second-year target/outcome measurement (Final to the end of SFY 2021); 

d) Data source; 

e) Description of data; and 

f) Data issues/caveats that affect outcome measures. 

Plan Table 1: Priority Area and Annual Performance Indicators 

1. Priority Area: 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: 

a) Baseline measurement (Initial data collected prior to and during SFY 2020): 

b) First-year target/outcome measurement (Progress to the end of SFY 2020): 

c) Second-year target/outcome measurement (Final to the end of SFY 2021): 

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.20 

20 http://www.samhsa.gov/grants/block-grants/laws-regulations 
Plan Table 2: State Agency Planned Expenditures

States must project how the SMHA and/or the SSA will use available funds to provide authorized services for the planning period for 

state fiscal years FFY 2020/2021.

Plan Table 2 State Agency Planned Expenditures

SABG ONLY include funds expended by the executive branch agency administering the SABG

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: 

State Identifier:

Source of Funds

ACTIVITY 

(See instructions for using Row 1.)

A. 

SABG

B. 

MH BG

C. Medicaid 

(Federal, State,

and local)

D. Other Federal 

Funds (e.g., ACF 

(TANF), CDC, CMS

(Medicare) 

SAMHSA, etc.)

E. State 

funds

F. Local funds 

(excluding local

Medicaid)

G. Other

1. Substance Abuse Prevention* and 

Treatment

a. Pregnant Women and Women 

with Dependent Children* $ $ $ $ $ $ 

b. All Other $ $ $ $ $ $ 

2. Primary Prevention** $ $ $ $ $ $ $ 

a. Substance Abuse Primary

Prevention $ $ $ $ $ $ 

b. Mental Health Primary

prevention*** $ $ $ $ $ $ 

3. Evidence-Based Practices for Early 

Serious Mental Illness including First

Episode Psychosis (10 percent of total 

award MHBG)****

$ $ $ $ $ $ 

4. Tuberculosis Services $ $ $ $ $ $ 

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

6. State Hospital $ $ $ $ $ 

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

$ $ $ $ $ $ $ 
Source of Funds

ACTIVITY 

(See instructions for using Row 1.)

A. 

SABG

B. 

MH BG

C. Medicaid 

(Federal, State,

and local)

D. Other Federal 

Funds (e.g., ACF 

(TANF), CDC, CMS

(Medicare) 

SAMHSA, etc.)

E. State 

funds

F. Local funds 

(excluding local

Medicaid)

G. Other

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

11. Subtotal (Rows 3, 6, 7, and 8) $ $ $ $ $ $ $ 

12. Total $ $ $ $ $ $ $ 

* Prevention other than primary prevention.

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

***While a state may use state or other funding for these services, the MHBG funds must be directed toward adults with SMI or children with SED.

**** Column 3B should include Early Serious Mental Illness programs funded through MHBG set aside

Plan Table 3: SABG Persons in need/receipt of SUD treatment 

Instructions to complete Table 3

In order to complete column B of the table, 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. 

In order to complete column C of the table, please refer to the most recent Treatment Episode Data Set (TEDS) data prepared and 

submitted to SAMHSA’s Behavioral Health Services Information System (BHSIS).

Please provide an explanation for any data cells for which the state does not have a data source.

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

Plan Table 4: SABG Planned Expenditures.
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

States must project how they will use SABG funds to provide authorized services as required by the SABG regulations. Plan Table 4 

must be completed for the FFY 2020 and FFY 2021 SABG awards. 

Plan Table 4 SABG Planned Expenditures 

State Identifier: 

Expenditure Category FFY 2020 SA Block Grant Award FFY 2021SA Block Grant Award 

1. Substance Abuse Prevention* and Treatment $ $ 

2. Primary Substance Abuse Prevention $ $ 

3. Early Intervention Services for HIV21 $ $ 

4. Tuberculosis Services $ $ 

5. Administration (SSA level only) $ $ 

6. Total $ $ 

* Prevention other than Primary Prevention 

21 For the purpose of determining the states and jurisdictions that are considered “designated states” as described in section 1924(b)(2) of Title XIX, Part B, Subpart II of the Public

Health Service Act (42 U.S.C. § 300x-24(b)(2)) and section 45 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 Centers for Disease Control and Prevention (CDC,), National Center for HIV/AIDS, Viral Hepatitis, STD and 

TB Prevention. The most recent HIV Surveillance Report will be 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 for 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. 
 

 

 

 

 

 

 

 

 

Table 5a and 5b - Primary Prevention Planned Expenditures 

States must spend no less than 20 percent of their SABG allotment on substance use disorder 

primary prevention strategies. These strategies are directed at individuals not identified to be in need 

of treatment. To report on their primary prevention planned expenditures, states must complete 

either Table 5a or Table 5b or may choose to complete both. If Table 5b is completed, the state must 

also complete Section 1926 –Tobacco on Table 5a. 

Table 5a SABG Primary Prevention Planned Expenditures 

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 2020 and FFY 2021 

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, please report them under “Other” in Table 5a. 

In most cases, the total amounts should equal the amounts reported on Plan Table 4, Row 2, Primary 

Prevention. The one exception is if the state chooses to use a portion of the primary prevention setaside to fund Non Direct Services/System Development activities. 

If the state chooses to report activities utilizing the IOM Model of Universal, Selective, and 

Indicated, complete Form 5b. If Form 5b is completed, the state must also complete Section 1926 –

Tobacco on Form 5a. 

Table 5b SABG 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 - 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 is in need of treatment. 

27 
 

 

 

 

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 - The six primary prevention strategies have been designed to encompass nearly all of the 

prevention activities. However, in the unusual case an activity does not fit one of the six strategies, 

it may be classified in the “Other” category.

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. 

In addition, 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 has not been identified 

based on individual risk. 

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). 

28 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

Plan Table 5a: SABG Primary Prevention Planned Expenditures 

State Identifier: 

Report Period From: To: 

A B C 

Strategy IOM Target FFY 2020 SA 

Block Grant 

Award 

FFY 2021 SA 

Block Grant 

Award 

1. Information Dissemination Universal $ $ 

Selected $ $ 

Indicated $ $ 

Unspecified $ $ 

2. Education Universal $ $ 

Selected $ $ 

Indicated $ $ 

Unspecified $ $ 

3. Alternatives Universal $ $ 

Selected $ $ 

Indicated $ $ 

Unspecified $ $ 

4. Problem Identification and 

Referral 

Universal $ $ 

Selected $ $ 

Indicated $ $ 

Unspecified $ $ 

5. Community-Based Processes Universal $ $ 

Selected $ $ 

Indicated $ $ 

Unspecified $ $ 

6. Environmental Universal $ $ 

Selected $ $ 

Indicated $ $ 

Unspecified $ $ 

7. Section 1926-Tobacco Universal $ $ 

Selected $ $ 

Indicated $ $ 

Unspecified $ $ 

8. Other Universal $ $ 

Selected $ $ 

Indicated $ $ 

Unspecified $ $ 

9. Total Prevention 

Expenditures 

$ $ 

Total SABG Award $ $ 

Planned Primary Prevention 

Percentage 

% % 

29 
 

 

 

 

 

 

 

 

 

 

 

 

Table 5b SABG Primary Prevention Planned Expenditures by IOM Category 

Table 5b Instructions: States that plan their primary prevention expenditures using the IOM model of 

universal, selective, and indicated should use Table 5b to list their FFY 2020 and FFY 2021 SABG planned 

expenditures in each of these categories. Note that if Form 5b is completed instead of Form 5a, the state must 

also complete Section 1926 - Tobacco on Form 5a. In most cases, the total amount should equal the amounts 

reported on Plan Table 3, Row 2, Primary 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. 

Institute of Medicine Classification: Universal, Selective, and Indicated: 

Universal: Activities targeted to the public or a whole population group that have not been identified based on 

individual risk. 

Universal Direct. Row 1 - Intervention s 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). 

Plan Table 5b: SABG Primary Prevention Planned 

Expenditures by IOM Category 

State Identifier: 

Activity 

FFY 2020 

SA Block 

Grant Award 

FFY 2021 

SA Block 

Grant Award 

Universal Direct $ $ 

Universal Indirect $ $ 

Selective $ $ 

Indicated $ $ 

Column Total $ $ 

Total SABG 

Award 

$ $ 

Planned Primary 

Prevention 

Percentage 

% % 

30 
 

 

 

 

 

 

 

 

 

 

 

 

 

Plan Table 5c: SABG Planned Primary Prevention Targeted Priorities 

States should identify the categories of substances the state BG plans to target with primary prevention set-aside 

dollars from the FFY 2020 and FFY 2021 SABG awards. 

Targeted Substances 

Alcohol 

Tobacco 

Marijuana 

Prescription Drugs 

Cocaine 

Heroin 

Inhalants 

Methamphetamine 

Synthetic Drugs (e.g., Bath salts, 

Spice, K2) 

Instructions: In the table below, identify the special population categories the state BG plans to targets with primary 

prevention set-aside dollars. 

Targeted Populations 

Students in College 

Military Families 

LGBTQQ 

American Indians/Alaska Natives 

African American 

Hispanic 

Homeless 

Native Hawaiian/Other Pacific Islanders 

Asian 

Rural 

Underserved Racial and Ethnic 

Minorities 

31 
 

 

 

 

 

 

 

 

 

 

 

Plan Table 6 

Categories for Expenditures for System Development/Non-Direct-Service Activities 

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, and if the preponderance of the activity fits within a category. 

We understand that a particular activity may cross categories, but try to identify the primary 

purpose or goal of the activity. For example, a state may utilize SABG funds to train personnel 

to conduct fidelity assessments of evidence-based practices. While this could fall under either 

training/education and/or quality assurance/improvement – if the primary purpose is to assure 

the implementation of EBPs, that expenditure would most likely be captured under quality 

assurance/improvement. 

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 Planning Council, or (OPTIONAL) 

Advisory Council for the SABG. 

32 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

- -

-

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 substance use disorder 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. 

Please enter the total amount of the block grant expended for each activity. 

Non Direct Services/System Development 

SABG/MHBG Table 6 

State Identifier: 

Report Period From: To: 

Activity A. MHBG B. SABG 

Treatment 

C. SABG 

Prevention 

D. SABG 

Combined 

* 

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 $ $ $ $ 

*Combined refers to non-direct service/system development expenditures that support both treatment and 

prevention systems 

33 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C. Environmental Factors and Plan 

1. The Health Care System, Parity and Integration - Question 1 and 2 are Required 

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

those who do not have these conditions.22 Early mortality is associated with broader health 

disparities and health equity issues such as socioeconomic status but “[h]ealth system factors”

such as access to care also play an important role in morbidity and mortality among these 

populations. Persons with mental illness and substance use disorders may benefit from strategies 

to control weight, encourage exercise, and properly treat such chronic health conditions as 

diabetes and cardiovascular disease.23 It has been acknowledged that there is a high rate of cooccurring M/SUD, with appropriate treatment required for both conditions.24 

Currently, 50 states have organizationally consolidated their mental and substance use disorder 

authorities in one fashion or another with additional organizational changes under 

consideration. More broadly, SAMHSA and its federal partners understand that such factors 

as education, housing, and nutrition strongly affect the overall health and well-being of 

persons with mental illness and substance use disorders.25 SMHAs and SSAs may wish to 

develop and support partnerships and programs to help address social determinants of health 

and advance overall health equity.26 For instance, some organizations have established 

medical-legal partnerships to assist persons with mental and substance use disorders in 

meeting their housing, employment, and education needs.27 

Health care professionals and persons who access M/SUD treatment services recognize the 

need for improved coordination of care and integration of physical and M/SUD with other 

health care in primary, specialty, emergency and rehabilitative care settings in the community. 

For instance, the National Alliance for Mental Illness has published materials for members to 

22 BG Druss et al. Understanding excess mortality in persons with mental illness: 17-year follow up of a nationally 

representative US survey. Med Care. 2011 Jun; 49(6):599-604; Bradley Mathers, Mortality among people who inject drugs: a 

systematic review and meta-analysis, Bulletin of the World Health Organization, 2013; 91:102–123 

http://www.who.int/bulletin/volumes/91/2/12-108282.pdf; MD Hert et al., Physical illness in patients with severe mental 

disorders. I. Prevalence, impact of medications and disparities in health care, World Psychiatry. Feb 2011; 10(1): 52–77 23 Research Review of Health Promotion Programs for People with SMI, 2012, http://www.integration.samhsa.gov/healthwellness/wellnesswhitepaper; About SAMHSA’s Wellness Efforts, https://https://www.samhsa.gov/wellnessinitiativewww.samhsa.gov/wellness-initiativeJW Newcomer and CH Hennekens, Severe Mental Illness and Risk of 

Cardiovascular Disease, JAMA; 2007; 298: 1794-1796; Million Hearts, https://www.samhsa.gov/health-care-health-systemsintegration; Schizophrenia as a health disparity, http://www.nimh.nih.gov/about/director/2013/schizophrenia-as-a-healthdisparity.shtml 

24 Comorbidity: Addiction and other mental illnesses, http://www.drugabuse.gov/publications/comorbidity-addiction-othermental-illnesses/why-do-drug-use-disorders-often-co-occur-other-mental-illnesses Hartz et al., Comorbidity of Severe Psychotic 

Disorders With Measures of Substance Use, JAMA Psychiatry. 2014; 71(3):248-254. doi:10.1001/jamapsychiatry.2013.3726; 

http://www.samhsa.gov/co-occurring/ 

25 Social Determinants of Health, Healthy People 2020, 

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

https://www.cdc.gov/nchhstp/socialdeterminants/https://www.cdc.gov/nchhstp/socialdeterminants/index.htmlindex.html 

26 http://www.samhsa.gov/health-disparities/strategic-initiatives 27 http://medical-legalpartnership.org/mlp-response/how-civil-legal-aid-helps-health-care-address-sdoh/ 

34 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

assist them in coordinating pediatric mental health and primary care.28 

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

substance use disorders.29 The state should illustrate movement towards integrated systems of 

care for individuals and families with co-occurring mental and substance use disorders. The 

plan should describe attention to management, funding, payment strategies that foster cooccurring capability for services to individuals and families with co-occurring mental and 

substance use disorders. Strategies supported by SAMHSA to foster integration of physical 

and M/SUD include: developing models for inclusion of M/SUD treatment in primary care; 

supporting innovative payment and financing strategies and delivery system reforms such as 

ACOs, health homes, pay for performance, etc.; promoting workforce recruitment, retention 

and training efforts; improving understanding of financial sustainability and billing 

requirements; encouraging collaboration between M/SUD providers, prevention of teen 

pregnancy, youth violence, Medicaid programs, and primary care providers such as Federally 

Qualified Health Centers; and sharing with consumers information about the full range of 

health and wellness programs. 

Health information technology, including EHRs and telehealth are examples of important 

strategies to promote integrated care.30 Use of EHRs – in full compliance with applicable 

legal requirements – may allow providers to share information, coordinate care, and improve 

billing practices. Telehealth is another important tool that may allow M/SUD prevention, 

treatment, and recovery to be conveniently provided in a variety of settings, helping to expand 

access, improve efficiency, save time, and reduce costs. Development and use of models for 

coordinated, integrated care such as those found in health homes31 and ACOs32 may be 

important strategies used by SMHAs and SSAs to foster integrated care. Training and 

assisting M/SUD providers to redesign or implement new provider billing practices, build 

capacity for third-party contract negotiations, collaborate with health clinics and other 

organizations and provider networks, and coordinate benefits among multiple funding sources 

28 Integrating Mental Health and Pediatric Primary Care, A Family Guide, 2011. https://www.integration.samhsa.gov/integratedcare-models/FG-Integrating,_12.22.pdf; Integration of Mental Health, Addictions and Primary Care, Policy Brief, 2011, 

https://www.ahrq.gov/downloads/pub/evidence/pdf/mhsapc/mhsapc.pdf; Abrams, Michael T. (2012, August 30). Coordination 

of care for persons with substance use disorders under the Affordable Care Act: Opportunities and Challenges. Baltimore, MD: 

The Hilltop Institute, UMBC. 

http://www.hilltopinstitute.org/publications/CoordinationOfCareForPersonsWithSUDSUnderTheACA-August2012.pdf; Bringing 

Behavioral Health into the Care Continuum: Opportunities to Improve Quality, Costs and Outcomes, American Hospital 

Association, Jan. 2012, http://www.aha.org/research/reports/tw/12jan-tw-behavhealth.pdf; American Psychiatric Association, 

http://www.psych.org/practice/professional-interests/integrated-care; Improving the Quality of Health Care for Mental and 

Substance-Use Conditions: Quality Chasm Series ( 2006), Institute of Medicine, National Affordable Care Academy of Sciences, 

http://books.nap.edu/openbook.php?record_id=11470&page=210; State Substance Abuse Agency and Substance Abuse Program 

Efforts Towards Healthcare Integration: An Environmental Scan, National Association of State Alcohol/Drug Abuse Directors, 

2011, http://nasadad.org/nasadad-reports 29 Health Care Integration, http:// samhsa.gov/health-reform/health-care-integration; SAMHSA-HRSA Center for Integrated 

Health Solutions, (http://www.integration.samhsa.gov/) 30 Health Information Technology (HIT), http://www.integration.samhsa.gov/operations-administration/hit; Characteristics of 

State Mental Health Agency Data Systems, Telebehavioral Health and Technical Assistance Series, 

https://www.integration.samhsa.gov/operations-administration/telebehavioral-health; State Medicaid Best Practice, Telemental 

and Behavioral Health, August 2013, American Telemedicine Association, http://www.americantelemed.org/home; National 

Telehealth Policy Resource Center, http://telehealthpolicy.us/medicaid; 31 Health Homes, http://www.integration.samhsa.gov/integrated-care-models/health-homes 32 New financing models, https://www.integration.samhsa.gov/financing 

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may be important ways to foster integrated care. SAMHSA encourages SMHAs and SSAs to 

communicate frequently with stakeholders, including policymakers at the state/jurisdictional 

and local levels, and State Mental Health Planning Council members and consumers, about 

efforts to foster health care coverage, access and integrate care to ensure beneficial outcomes. 

SMHAs and SSAs also may work with state Medicaid agencies, state insurance 

commissioners, and professional organizations to encourage development of innovative 

demonstration projects, alternative payment methodologies, and waivers/state plan 

amendments that test approaches to providing integrated care for persons with M/SUD and 

other vulnerable populations.33 Ensuring both Medicaid and private insurers provide required 

preventive benefits also may be an area for collaboration.34 

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

Medicaid.35 Roughly, 30 percent of persons who are dually eligible have been diagnosed with 

a mental illness, more than three times the rate among those who are not dually eligible.36 

SMHAs and SSAs also should collaborate with state Medicaid agencies and state insurance 

commissioners to develop policies to assist those individuals who experience health insurance 

coverage eligibility changes due to shifts in income and employment.37 Moreover, even with 

expanded health coverage available through the Marketplace and Medicaid and efforts to 

ensure parity in health care coverage, persons with M/SUD conditions still may experience 

challenges in some areas in obtaining care for a particular condition or in finding a provider.38 

SMHAs and SSAs should remain cognizant that health disparities may affect access, health 

care coverage and integrated care of M/SUD conditions and work with partners to mitigate 

regional and local variations in services that detrimentally affect access to care and integration. 

SMHAs and SSAs should work with partners to ensure recruitment of diverse, well-trained 

staff and promote workforce development and ability to function in an integrated care 

33 Waivers, http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/Waivers.html; Coverage and 

Service Design Opportunities for Individuals with Mental Illness and Substance Use Disorders, CMS Informational Bulletin, 

Dec. 2012, http://medicaid.gov/Federal-Policy-Guidance/Downloads/CIB-12-03-12.pdf 34 What are my preventive care benefits? https://www.healthcare.gov/what-are-my-preventive-care-benefits/; Interim Final Rules 

for Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services Under the Patient Protection 

and Affordable Care Act, 75 FR 41726 (July 19, 2010); Group Health Plans and Health Insurance Issuers Relating to Coverage of 

Preventive Services Under the Patient Protection and Affordable Care Act, 76 FR 46621 (Aug. 3, 2011); 

http://www.hhs.gov/healthcare/facts/factsheets/2010/07/preventive-serviceslisthttp://www.hhs.gov/healthcare/facts/factsheets/2010/07/preventive-services-list.html.html 35 Medicare-Medicaid Enrollee State Profiles, http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-MedicaidCoordination/Medicare-Medicaid-Coordination-Office/StateProfiles.html; About the Compact of Free Association, 

http://uscompact.org/about/cofa.php 

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

June 2013, http://www.cbo.gov/publication/44308 37 BD Sommers et al. Medicaid and Marketplace Eligibility Changes Will Occur Often in All States; Policy Options can Ease 

Impact. Health Affairs. 2014; 33(4): 700-707 

38 TF Bishop. Acceptance of Insurance by Psychiatrists and the Implications for Access to Mental Health Care, JAMA 

Psychiatry. 2014;71(2):176-181; JR Cummings et al, Race/Ethnicity and Geographic Access to Medicaid Substance Use 

Disorder Treatment Facilities in the United States, JAMA Psychiatry. 2014; 71(2):190-196; JR Cummings et al. Geography and 

the Medicaid Mental Health Care Infrastructure: Implications for Health Reform. JAMA Psychiatry. 2013; 70(10):1084-1090; 

JW Boyd et al. The Crisis in Mental Health Care: A Preliminary Study of Access to Psychiatric Care in Boston. Annals of 

Emergency Medicine. 2011; 58(2): 218 

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environment.39 Psychiatrists, psychologists, social workers, addiction counselors, 

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

understand integrated care models, concepts, and practices. 

Parity is vital to ensuring persons with mental health conditions and substance use disorders 

receive continuous, coordinated, care. Increasing public awareness about MHPAEA could 

increase access to M/SUD services, provide financial benefits to individuals and families, and 

lead to reduced confusion and discrimination associated with mental illness and substance use 

disorders. Block grant recipients should continue to monitor federal parity regulations and 

guidance and collaborate with state Medicaid authorities, insurance regulators, insurers, 

employers, providers, consumers and policymakers to ensure effective parity implementation and 

comprehensive, consistent communication with stakeholders. The SSAs, SMHAs and their 

partners may wish to pursue strategies to provide information, education, and technical 

assistance on parity-related issues. Medicaid programs will be a key partner for recipients of 

MHBG and SABG funds and providers supported by these funds. The SSAs and SMHAs should 

collaborate with their states’ Medicaid authority in ensuring parity within Medicaid programs. 

SAMHSA encourages states to take proactive steps to improve consumer knowledge about 

parity. As one plan of action, states can develop communication plans to provide and address 

key issues. 

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

Department of Health and Human Services (HHS) and partners have developed the National 

Quality Strategy, which includes information and resources to help promote health, good 

outcomes, and patient engagement. SAMHSA’s National Behavioral Health Quality

Framework includes core measures that may be used by providers and payers.40 

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

Territories, tribal entities and those jurisdictions that have signed a Compact of Free 

Association with the United States and are uniquely impacted by certain Medicaid provisions 

or are ineligible to participate in certain programs.41 However, these jurisdictions should 

collaborate with federal agencies and their governmental and non-governmental partners to 

expand access and coverage. Furthermore, the jurisdiction should ensure integration of 

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

substance use disorders. 

Please respond to the following items in order to provide a description of the healthcare system 

and integration activities: 

39 Hoge, M.A., Stuart, G.W., Morris, J., Flaherty, M.T., Paris, M. & Goplerud E. Mental health and addiction workforce 

development: Federal leadership is needed to address the growing crisis. Health Affairs, 2013; 32 (11): 2005-2012; SAMHSA 

Report to Congress on the Nation’s Substance Abuse and Mental Health Workforce Issues, January 2013,

http://store.samhsa.gov/shin/content/PEP13-RTC-BHWORK/PEP13-RTC-BHWORK.pdf; Creating jobs by addressing primary 

care workforce needs, https://obamawhitehouse.archives.gov/the-press-office/2012/04/11/fact-sheet-creating-health-care-jobsaddressing-primary-care-workforce-n 

40 About the National Quality Strategy, http://www.ahrq.gov/workingforquality/about.htm; National Behavioral Health Quality 

Framework, Draft, August 2013, http://samhsa.gov/data/NBHQF 

41 Letter to Governors on Information for Territories Regarding the Affordable Care Act, December 2012, 

http://www.cms.gov/cciio/resources/letters/index.html; Affordable Care Act, Indian Health Service, http://www.ihs.gov/ACA/ 

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3. 

 

 

 

 

4. 

 

5. 

 

 

 

 

 

 

 

1. Describe how the state integrates mental health and primary health care, including services for 

individuals with co-occurring mental and substance use disorders, in primary care settings or 

arrangements to provide primary and specialty care services in community-based mental and 

substance use disorders settings. 

2. Describe how the state provide services and supports towards integrated systems of care for 

individuals and families with co-occurring mental and substance use disorders, including 

management, funding, payment strategies that foster co-occurring capability. 

Is there a plan for monitoring whether individuals and families have access to M/SUD 

services offered through QHPs? 

a) Yes No 

Medicaid? 

b) Yes No 

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

Is the SSA/SMHA involved in any coordinated care initiatives in the state? 

Yes No 

6. Do the M/SUD providers screen and refer for: 

a) Prevention and wellness education? 

Yes No 

b) Health risks such as: 

ii) heart disease, Yes No 

iii) hypertension, Yes No 

iv) high cholesterol Yes No 

v) diabetes Yes No 

c) Recovery supports? 

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Yes No 

7. Is the SSA/SMHA involved in the development of alternative payment methodologies, 

including risk-based contractual relationships that advance coordination of care? 

Yes No 

8. Is the SSA and SMHA involved in the implementation and enforcement of parity protections 

for mental and substance use disorder services? 

Yes No 

9. What are the issues or problems that your state is facing related to the implementation and 

enforcement of parity provisions? 

10. 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 

2. Health Disparities - Requested 

In accordance with the HHS Action Plan to Reduce Racial and Ethnic Health Disparities42, 

Healthy People, 202043, National Stakeholder Strategy for Achieving Health Equity44, 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 

42 http://www.minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf 43 http://www.healthypeople.gov/2020/default.aspx 44https://www.minorityhealth.hhs.gov/npa/files/Plans/NSS/NSS_07_Section3.pdf 

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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 

Appropriate Services in Health and Health Care (CLAS).45 

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.”46 

Collecting appropriate data is 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.47 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.48 

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 evidence-based and 

promising practices in a manner that meets the needs of the populations they serve. 

In the block grant application, states define the 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 

45 http://www.ThinkCulturalHealth.hhs.gov 46 http://www.minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf 47 https://aspe.hhs.gov/basic-report/hhs-implementation-guidance-data-collection-standards-race-ethnicity-sex-primarylanguage-and-disability-status 

48 : 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 

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metabolic disorders among Latino adults with SMI; and American Indian/Alaska Native youth 

may have an increased incidence of underage binge drinking due to coping patterns related to 

historical trauma within the American Indian/Alaska Native community. While these factors 

might not be pervasive among the general population served by the block grant, they may be 

predominant among subpopulations or groups vulnerable to disparities. 

To address and ultimately reduce disparities, it is important for states to have a detailed 

understanding of who is 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 

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7) Does the state have any activities related to this section that you would like to highlight? 

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 states 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 

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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 

individuals with mental illness and substance use disorders, including youth and adults with 

chronic addiction disorders, adults with SMI, and children and youth with SED. The evidence 

builds on the evidence and consensus standards that have been developed in many national 

49 reports over the last decade or more. These include reports by the Surgeon General, The New 

Freedom Commission on Mental Health,

50 the IOM,51 NQF, and the Interdepartmental Serious 

Mental Illness Coordinating Committee (ISMICC).52 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.”53 

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)

54 are best practice guidelines for 

the 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 alcohol and other drug disorders are increasingly 

recognized as a major health problem. 

SAMHSA’s Evidence-Based Practice Knowledge Informing Transformation (KIT)55 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 

49 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 50 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. 51 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. 

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

Conditions: Evidence-Based Treatment Practices. Washington, DC: National Quality Forum. 53http://psychiatryonline.org/ 

54 http://store.samhsa.gov 55 http://store.samhsa.gov/shin/content//SMA08-4367/HowtoUseEBPKITS-ITC.pdf 

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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. 

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? 

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

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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 

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 a substance use 

disorder, 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. 

State 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 early serious mental illness, 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 

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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 such 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. 

1. Does the state have policies for addressing early serious mental illness (ESMI)? 

Yes No 

2. Has the state implemented any evidence-based practices (EBPs) for those with ESMI? 

Yes No 

If yes, please list the EBPs and provide a description of the programs that the state currently 

funds to implement evidence-based practices for those with ESMI 

3. How does the state promote the use of evidence-based practices for individuals with ESMI and 

provide comprehensive individualized treatment or integrated mental and physical health 

services? 

4. Does the state coordinate across public and private sector entities to coordinate treatment and 

recovery supports for those with ESMI? 

Yes No 

5. Does the state collect data specifically related to ESMI? 

Yes No 

6. Does the state provide trainings to increase capacity of providers to deliver interventions 

related to ESMI? 

Yes No 

7. Please provide an updated description of the State’s chosen EBPs for the 10 percent set-aside 

for ESMI. 

46 
 

 

 

8. Please describe the planned activities for FFY 2020 and FFY 2021 for your state’s ESMI 

programs including psychosis? 

9. Please explain the state’s provision for collecting and reporting data, demonstrating the impact 

of the 10 percent set-aside for ESMI. 

10. Please list the diagnostic categories identified for your state’s ESMI programs 

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

5. Person Centered Planning (PCP) –Required for MHBG 

States must engage adults with a serious mental illness or children with a serious emotional 

disturbance and their caregivers where appropriate in making health care decisions, including 

47 
 

 

 

 

 

 

 

 

 

activities that enhance communication among individuals, families, caregivers, and treatment 

providers. Person-centered planning 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, education, family relationships, and 

treatments are part of a written plan that is consistent with the person’s needs and desires. 

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 enhance communication. 

4. Describe the person-centered planning process in your state. 

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 

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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, 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. 

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 

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3) 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. 

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 Consultation56 to submit plans on how it will 

engage in regular and meaningful consultation and collaboration with tribal officials in the 

development of federal policies that have tribal implications. 

Improving the health and well-being of tribal nations is contingent upon understanding their 

specific needs. Tribal consultation is an essential tool in achieving that understanding. 

Consultation is an enhanced form of communication, which emphasizes trust, respect, and 

shared responsibility. It is an open and free exchange of information and opinion among 

parties, which leads to mutual understanding and comprehension. Consultation is integral to a 

deliberative process that results in effective collaboration and informed decision-making with 

the ultimate goal of reaching consensus on issues. 

In the context of the block grant funds awarded to tribes, SAMHSA views consultation as a 

government-to-government interaction and should be distinguished from input provided by 

individual tribal members or services provided for tribal members whether on or off tribal 

lands. Therefore, the interaction should be attended by elected officials of the tribe or their 

designees and by the highest possible state officials. As states administer health and human 

https://www.energy.gov/sites/prod/files/Presidential%20Memorandum%20Tribal%20Consultation%20%282009%2 

9.pdf 

50 

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51

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 have the state conducted with federally recognized tribes? 

2. What specific concerns were raised during the consultation session(s) noted above? 

3. 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. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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 be in need of 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 

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 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 

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)? 

52 
 

 

 

 

 

 

 

 

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) 

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) 

53 
 

 

 

 

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, (if yes, please explain) 

ii) If no, please explain how SABG funds are allocated: 

Capacity Building 

6. Does your state have a statewide licensing or certification program for the substance use 

disorder prevention workforce? 

a) Yes (if yes, please describe) 

b) No 

54 
 

7. Does your state have a formal mechanism to provide training and technical assistance to the 

substance use disorder prevention workforce? 

a) Yes (if yes, please describe mechanism used) 

b) No 

8. 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 

Planning 

9. Does your state have a strategic plan that addresses substance use disorder prevention that 

was developed within the last five years? 

a) Yes (If yes, please attach the plan in BGAS) 

b) No 

10. 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) 

11. 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 

55 
 

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 

12. Does your state have an Advisory Council that provides input into decisions about the use of 

SABG primary prevention funds? 

a) Yes No 

13. 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? 

Implementation 

14. 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. 

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) 

56 
 

 

 

15. 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: 

e) Community-Based Processes: 

f) Environmental: 

16. 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) 

b) No 

57 
 

Evaluation 

17. Does your state have an evaluation plan for substance use disorder prevention that was 

developed within the last five years? 

a) Yes (If yes, please attach the plan in BGAS) 

b) No 

18. 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 

19. 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) 

20. Please check those outcome measures listed below that your state collects on its SABG 

funded prevention services: 

58 
 

a) 30-day use of alcohol, tobacco, prescription drugs, etc. 

b) Heavy use 

Binge use 

Perception of harm 

c) Disapproval of use 

d) Consequences of substance use (e.g. alcohol-related motor vehicle crashes, drugrelated mortality) 

e) Other (please describe) 

9. Statutory Criterion for MHBG (Required for MHBG) 

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 mental and substance 

use disorders. 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 mental and substance use disorders 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 

59 
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, 

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 

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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 

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 their 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 

61 
 

Provides outreach to and services for individuals who experience homelessness; communitybased services to individuals in rural areas; and community-based services to older adults. 

Describe your state’s targeted services to rural population. 

a. Describe your state’s targeted services to the homeless population.

b. 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.

62 
 

 

 

 

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; 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 

63 
 

 

 

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. 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. 

64 
 

 

 

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. 

Tuberculosis (TB) 

65 
 

 

1. Does your state currently maintain an agreement, either directly or through arrangements 

with other public and nonprofit private entities to make available tuberculosis services 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 current have an agreement to provide treatment for persons with substance 

use disorders 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 tele-health and social media support services? 

Yes No 

c) Business agreement/MOU with established community agencies/organizations serving 

persons with HIV/AIDS? 

Yes No 

Syringe Service Programs 

66 
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 in place an agreement to ensure that 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 

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: 

67 
i) MAT 

(1) Yes No 

ii) Tele-health 

(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 

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 

68 
 

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 

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 

69 
 

 

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 

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? 

70 
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 substance use disorders 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 

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 

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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. 

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 

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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 2018-FFY 2019? 

a) Yes No 

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

12. Trauma -Requested 

Trauma57 is a widespread, harmful, and costly public health problem. It occurs because of 

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 the impact of 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 

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 

57 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. 

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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 Trauma58 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 

5) Does the state have any activities related to this section that you would like to highlight. 

58 Ibid 

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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.59 

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.

60 

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 

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: 

59 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. 60 http://csgjusticecenter.org/mental-health/ 

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1. Does the state (SMHA and SSA) have a plan for coordinating with the criminal and juvenile 

justice systems on diversion of individuals with mental and/or substance use disorders 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]. 

SAMHSA strongly encourages that the states require treatment facilities providing clinical care 

to those with substance use disorders demonstrate that they both have the capacity and staff 

expertise to use MAT or have collaborative relationships with other providers that can provide 

76 
 

 

 

 

 

 

 

 

 

 

 

 

the appropriate MAT services clinically needed. 

Individuals with substance use disorders who have a disorder for which there is an FDAapproved 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 substance use 

disorders 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 substance use disorder, 

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 substance use disorders, and advocacy with state payers. 

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15. Crisis Services - Requested 

In the on-going development of efforts to build an robust system of evidence-based care for 

persons diagnosed with SMI, SED and SUD and their families via a coordinated continuum of 

treatments, services and supports, growing attention is being paid across the country to how 

states and local communities identify and effectively respond to, prevent, manage and help 

individuals, families, and communities recover from M/SUD crises. SAMHSA has recently 

released a publication, Crisis Services Effectiveness, Cost Effectiveness and Funding Strategies 

that states may find helpful.61 SAMHSA has taken a leadership role in deepening the 

understanding of what it means to be in crisis and how to respond to a crisis experienced by 

people with M/SUD conditions and their families. 

According to SAMHSA’s publication, Practice Guidelines: Core Elements for Responding to 

Mental Health Crises62, 

“Adults, children, and older adults with an SMI or emotional disorder often lead 

lives characterized by recurrent, significant crises. These crises are not the 

inevitable consequences of mental disability, but rather represent the combined 

impact of a host of additional factors, including lack of access to essential services 

and supports, poverty, unstable housing, coexisting substance use, other health 

problems, discrimination, and victimization.”

A crisis response system will have the capacity to prevent, recognize, respond, deescalate, and follow-up from crises across a continuum, from crisis planning, to early 

stages of support and respite, to crisis stabilization and intervention, to post-crisis followup and support for the individual and their family. SAMHSA expects that states will 

build on the emerging and growing body of evidence for effective community-based 

crisis-prevention and response systems. Given the multi-system involvement of many 

individuals with M/SUD issues, the crisis system approach provides the infrastructure to 

improve care coordination and outcomes, manage costs, and better invest resources. The 

following are an array of services and supports used to address crisis response. Please 

check those that are used in your state: 

1. Crisis Prevention and Early Intervention 

a) Wellness Recovery Action Plan (WRAP) Crisis Planning 

b) Psychiatric Advance Directives 

c) Family Engagement 

d) Safety Planning 

e) Peer-Operated Warm Lines 

f) Peer-Run Crisis Respite Programs 

61 http://store.samhsa.gov/product/Crisis-Services-Effectiveness-Cost-Effectiveness-and-FundingStrategies/SMA14-4848 

62 Practice Guidelines: Core Elements for Responding to Mental Health Crises. HHS Pub. No. SMA-09-4427. 

Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 

2009. http://store.samhsa.gov/product/Core-Elements-for-Responding-to-Mental-Health-Crises/SMA09-4427 

78 
 

 

 

 

 

 

 

 

 

 

g) Suicide Prevention 

2. Crisis Intervention/Stabilization: 

a) Assessment/Triage (Living Room Model) 

b) Open Dialogue 

c) Crisis Residential/Respite 

d) Crisis Intervention Team/ Law Enforcement 

e) Mobile Crisis Outreach 

f) Collaboration with Hospital Emergency Departments and Urgent Care 

Systems 

3. Post Crisis Intervention/Support: 

a) Peer Support/Peer Bridgers 

b) Follow-Up Outreach and Support 

c) Family-to-Family engagement 

d) Connection to care coordination and follow-up clinical care for individuals in 

crisis 

e) Follow-up crisis engagement with families and involved community 

members) 

f) Recovery community coaches/peer recovery coaches 

g) Recovery community organization 

4. 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. 

16. Recovery - Required 

The implementation of recovery supports and services are imperative for providing 

comprehensive, quality M/SUD care. The expansion in access to and coverage for health care 

compels SAMHSA to promote the availability, quality, and financing of vital services and 

support systems that facilitate recovery for individuals. Recovery encompasses the spectrum of 

individual needs related to those with mental disorders and/or substance use disorders. Recovery 

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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 recovery 

guide the approach to person-centered care that is inclusive of shared decision-making. The 

continuum of care for these conditions includes psychiatric and psychosocial interventions to 

address acute episodes or recurrence of symptoms associated with an individual’s mental or 

substance use disorder. Because mental and substance use disorders are chronic conditions, 

systems and services are necessary to facilitate the initiation, stabilization, and management of 

long-term recovery. 

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; 

• 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 Technical Assistance 

and Training Centers in each region. SAMHSA strongly encourages states to take proactive steps 

to implement recovery support services. To accomplish this goal and support the wide-scale 

adoption of recovery supports in the areas of health, home, purpose, and community, SAMHSA 

has launched Bringing Recovery Supports to Scale Technical Assistance Center Strategy (BRSS 

TACS). BRSS TACS assists states and others to promote adoption of recovery-oriented 

supports, services, and systems for people in recovery from substance use and/or mental 

disorders. 

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 and create resources for new consumer, family, and youth networks; recovery 

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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. 

Please respond to the following: 

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) Block grant funding of 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 

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 

substance use disorders in your state. 

5. Does the state have any activities that it would like to highlight? 

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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. 

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 

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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 hospital 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. 

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 substance use disorders. 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.63 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 24.64 

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.65 

It is also important to note that 11 percent of high school students have a diagnosable substance 

use disorder involving nicotine, alcohol, or illicit drugs, and nine out of 10 adults who meet 

clinical criteria for a substance use disorder started smoking, drinking, or using illicit drugs 

before the age of 18. Of people who started using before the age of 18, one in four will 

develop an addiction compared to one in twenty-five who started using substances after age 

21.66 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 

63 Centers for Disease Control and Prevention, (2013). Mental Health Surveillance among Children — United States, 2005-2011. 

MMWR 62(2). 

64 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. 65 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. 66 The National Center on Addiction and Substance Abuse at Columbia University. (June, 2011). Adolescent Substance Abuse: 

America’s #1 Public Health Problem.

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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 

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.67 

According to data from the 2015 Report to Congress68 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 

67 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 

68 http://www.samhsa.gov/sites/default/files/programs_campaigns/nitt-ta/2015-report-to-congress.pdf 

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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., like 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 

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: 

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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? 

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. 

86 
 

 

 

 

 

 

 

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 

5. Have you begun any targeted or statewide initiatives since the FFY 2018 - 2019 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 

87 
 

 

 

 

 

 

 

 

 

 

 

 

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 mental and substance use disorders, 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 

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? 

88 
 

 

 

 

 

 

 

 

 

 

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. 

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, 

SUD 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 

89 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

implementing a PC, SAMHSA has created Best Practices for State Behavioral Health Planning 

Councils: The Road to Planning Council Integration.

69 

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: 

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, 

SUD 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. 

69 https://www.samhsa.gov/sites/default/files/manual-planning-council-best-practices-2014.pdf 

90 
 

 

 

 

 

 

 

Additionally, please complete the Advisory Council Members and Behavioral Health Advisory 

Council Composition by Member Type forms.70 

70 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. 

91 
 

 

 

 

 

 

 

 

 

 

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 

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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. 

93 
 

 

 

 

 

 

 

 

 

 

 

 

 

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 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. 

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: 

c) Other (e.g., public service announcements, print media) 

Yes No 

94 
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 

AOT Assisted Outpatient Treatment 

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 

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 

Immunodeficiency Virus (HIV) 

ESMI Early Serious Mental Illness 

95 
96

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

NOMS National Outcome Measures 

NQF National Quality Forum 
97

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 

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 

U.S.C. United States Code 

VA U.S. Department of Veterans Affairs 
98

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/BILLS

-114hr34enr.pdf

Link 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/Characteristicsof-State-Mental-Health-Agency-DataSystems/SMA08-4361

Reviews current information technology (IT) systems and technology 

implementation efforts in state mental health agencies. Reports key 

findings on IT and structure, client-level and claims-level data, 

linking to other state data, and electronic health records. 

(Downloadable report)

Children Mental Health

https://store.samhsa.gov/product/Comprehensive

-Community-Mental-Health-Services-forChildren-and-Their-Families-ProgramEvaluation-Findings-ExecutiveSummary/PEP12-CMHI0608SUM

Presents program evaluation findings of a federally funded initiative 

that supports systems of care for community-based mental health 

services for children, youth, and their families. Reports on FFY2010 

data that track service characteristics, use, and outcomes.

(Downloadable report)

Co-Occurring Resources 

and Models http://www.samhsa.gov/co-occurring/

SAMHSA's webpage dedicated to co-occurring models and practice. 

Includes: resources, webinars, public resource links and more.
99

TOPIC LINK DESCRIPTION

Health Care Integration

http://www.samhsa.gov/health-care-healthsystems-integrationOverview of SAMHSA Health Care Integration initiatives and links 

to resources and information about health care integration

Health Homes

http://www.integration.samhsa.gov/integratedcare-models/health-homes

SAMHSA'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 http://www.samhsa.gov/health-financing

SAMHSA guides, trainings and technical assistance resources around 

health reform implementation.

Integrated Treatment for 

Co-Occurring Disorders

Evidence-Based Practices 

(EBP) KIT http://store.samhsa.gov/product/SMA08-4367

Provides practice principles about integrated treatment for cooccurring disorders, an approach that helps people recover by

offering 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-assistedtreatment SAMHSA's resources, guides and TIPs on MAT

Mental Health and 

Substance Abuse Block

Grant Laws and 

Regulations 

http://www.samhsa.gov/grants/blockgrants/laws-regulationsLinks to the laws and regulations that govern the Mental Health and 

Substance Abuse Block Grants
100

TOPIC LINK DESCRIPTION

Mental Health Crisis

https://store.samhsa.gov/product/Core-Elementsfor-Responding-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/nationalhiv-aids-strategy/nhas-updateJuly 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 EvidenceBased Practices Resource 

Center

https://www.samhsa.gov/ebp-resource-center

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.
101

TOPIC LINK DESCRIPTION

National Strategy for 

Suicide Prevention

http://store.samhsa.gov/product/NationalStrategy-for-Suicide-Prevention-2012-Goals- andObjectives-for-Action/PEP12-NSSPGOALS

Outlines a national strategy to guide suicide prevention actions. 

Includes 13 goals and 60 objectives across four strategic 

directions: wellness and empowerment; prevention services; 

treatment and support services; and surveillance, research, and 

evaluation. (Downloadable report)

Olmstead

http://www.samhsa.gov/laws-regulationsguidelines/civil-rights-protections

Links to the Olmstead decision document, as well as, a report that 

offers a basic primer on supportive housing, as well as a thorough 

review of states’ current Olmstead planning efforts in this area

Parity

http://www.medicaid.gov/Federal-PolicyGuidance/downloads/SHO-13-001.pdf

Letter from Medicaid on Application of the Mental Health Parity and

Addiction Equity Act to Medicaid MCOs, CHIP, and Alternative 

Benefit (Benchmark) Plans

Prevention of Underage 

Drinking http://www.ncbi.nlm.nih.gov/books/NBK44360/

The Surgeon General's Call to Action To Prevent and Reduce 

Underage Drinking seeks to engage all levels of government as well 

as individuals and private sector institutions and organizations in a 

coordinated, multifaceted effort to prevent and reduce underage 

drinking and its adverse consequences.

Recovery http://www.samhsa.gov/recovery/ SAMHSA's resources, guides and technical assistance on recovery

SAMHSA.gov Data 

Resources http://www.samhsa.gov/data/

Links to SAMHSA data sets including: NSDUH, DAWN,

NSSATS/NMHSS, TEDS, Uniform Reporting System (URS), 

National and State Barometers, etc.

SAMHSA's Evidenced 

Based Practice 

Knowledge Information 

Transformation (KIT)

http://store.samhsa.gov/product/AssertiveCommunity-Treatment-ACT-Evidence-BasedPractices-EBP-KIT/SMA08-4345

SAMHSA’s Evidence-Based Practice Knowledge Informing 

Transformation (KIT)[1] were developed to help move the latest 

information available on effective behavioral health practices into

community-based service delivery.

Substance Abuse for 

Women 

http://www.samhsa.gov/women-childrenfamilies

Guidance on components of quality 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.
102

TOPIC LINK DESCRIPTION

Telehealth Policy Resource

http://telehealthpolicy.us/medicaid

Telehealth Medicaid Policy site that provides telehealth laws 

and reimbursement by state, telehealth policy PDF and a 

review of pending legislations

Trauma & Violence http://www.samhsa.gov/trauma-violence

Includes information around violence and trauma, including the 

definition and review of trauma informed care.

Criminal & Juvenile 

Justice http://www.samhsa.gov/criminal-juvenile-justice

Review of behavioral health services and resources in the criminal 

justice and juvenile justice systems.

Tribal Consultation

https://obamawhitehouse.archives.gov/the-pressoffice/memorandum-tribal-consultation-signedpresident

The White House memorandum regarding the requirements related to 

tribal consultation