Block Grant Reporting Section 

CFDA 93.959 

Substance Abuse 

Prevention and Treatment 

Block Grant 

(SABG) 

U.S. Department of Health and Human Services 

Substance Abuse and Mental Health Services Administration 
 

Table of Contents 

A. Introduction 

B. Annual Update 

SABG Table 1 Priority Area and Annual Performance Indicators – Progress Report 

C. State Agency Expenditure Reports 

SABG Table 2a - State Agency Expenditure Report 

SABG Table 2b - COVID-19 Relief Funds Expenditure by Service 

SABG Table 3a - Syringe Services Program 

SABG Table 3b - Expenditures for Syringe Services Programs (SSPs) Program Information 

SABG Table 4 - SABG State Agency Expenditure Compliance Report 

SABG Table 5a - SABG Primary Prevention Expenditures 

SABG Table 5b - SABG Primary Prevention Targeted Priorities 

SABG Table 6 - Systems Development/Non-Direct Service Activities Expenditure 

SABG Table 7 - SABG Statewide Entity Inventory 

SABG Table 8a - Maintenance of Effort for State Expenditures for Substance Abuse Prevention and Treatment 

SABG Table 8b - Base and Maintenance of Effort for Expenditures for Services to Pregnant Women and Women with Dependent 

Children 

D. Population and Services Reports 

SABG Table 9 - Prevention Strategy Report 

SABG Table 10 - Treatment Utilization Matrix 

SABG Table 11a - Number of Persons Served (Unduplicated Count) for Alcohol and Other Drug Use 

SABG Table 11b - COVID-19 Number of Persons Served (Unduplicated Count) for Alcohol and Other Drug Use 

SABG Table 11c - Sex, Sexual Orientation, and Gender Identity Number of Persons Served (Unduplicated Count) for Alcohol and 

Other Drug Use 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SABG Table 12 - SABG HIV Early Intervention Services in Designated States 

SABG Table 13 - Charitable Choice 

E. Performance Data and Outcomes 

Treatment Performance Measures 

SABG Table 14 - Employment/Education Status 

SABG Table 15 - Stability of Housing 

SABG Table 16 - Criminal Justice Involvement 

SABG Table 17 - Change in Abstinence–Alcohol Use 

SABG Table 18 - Change in Abstinence – Other Drug Use 

SABG Table 19 - Change in Social Support of Recovery 

SABG Table 20 - Retention 

Prevention Performance Measures 

SABG Table 21 - Reduced Morbidity–Abstinence from Drug Use/Alcohol Use; Measure: 30 Day Use 

SABG Table 22 - Reduced Morbidity –Abstinence from Drug Use/Alcohol Use; Measure: Perception of Risk/Harm of Use 

SABG Table 23 - Reduced Morbidity–Abstinence from Drug Use/Alcohol Use; Measure: Age of First Use 

SABG Table 24 - Reduced Morbidity–Abstinence from Drug Use/Alcohol Use; Measure: Perception of Disapproval/Attitudes 

SABG Table 25 - Employment/Education; Measure: Perception of Workplace Policy 

SABG Table 26 - Employment/Education; Measure: Average Daily School Attendance Rate 

SABG Table 27 - Crime and Criminal Justice; Measure: Alcohol-Related Traffic Fatalities 

SABG Table 28 - Crime and Criminal Justice; Measure: Alcohol and Drug Related Arrests 

SABG Table 29 - Social Connectedness; Measure: Family Communications around Drug and Alcohol Use 

SABG Table 30 - Retention; Measure: Percentage of Youth Seeing, Reading, Watching, or Listening to a Prevention Message 

SABG Table 31-35 – Reporting Period – Start and End Dates for Information Reported on Tables 31, 32, 33, 34, and 35 

SABG Table 31 - Individual-Based Programs and Strategies; Measure: Number of Persons Served by Age, Gender, Race, and 

Ethnicity 

SABG Table 32 - Population-Based Programs and Strategies; Measure: Number of Persons Served by Age, Gender, Race, and 

Ethnicity 
 

 

 

 

 

 

 

 

 

 

SABG Table 33 - Number of Persons Served by Type of Intervention 

SABG Table 34 - Number of Evidence-Based Programs by Types of Intervention. 

SABG Table 35 - Number of Evidence-based Programs and Strategies, and Total SA Block Grant Funds Spent on Evidence-Based 

Programs/ Strategies. 

Section A. Introduction 

Section 1942(a) of Title XIX, Part B, Subpart III of the Public Health Service Act (42 U.S.C. § 300x-52(a)) requires the Secretary of the U.S. 

Department of Health and Human Services, acting through the Administrator of the Substance Abuse and Mental Health Services 

Administration (SAMHSA), to determine the extent to which states1 have implemented the State Plan for the preceding fiscal year. The 

purpose of the Substance Abuse Prevention and Treatment Block Grant (SABG) Annual Report is to provide information to assist the 

Secretary in making this determination. 

States are required to prepare and submit an annual report that includes expenditure summaries for (1) the state fiscal year (SFY) immediately 

preceding the federal fiscal year for which the state is applying for funds; and (2) the obligation and expenditure period of the Substance 

Abuse Prevention and Treatment Block Grant (SABG) Notice of Award (NoA) subject to CSAT compliance review (Compliance Award), in 

the format provided in this guidance. The SABG Annual Report will address the purposes for which the SABG funds were expended, the 

SABG sub-recipients, and the authorized activities and services purchased with such funds. Particular attention should be given to the 

progress made toward accomplishing the goals and performance indicators identified in the states’ and jurisdictions’ plans. 

All states are required to prepare and submit their respective SABG Annual Reports utilizing SAMHSA’s Web Block Grant Application 

System (BGAS). Annual reports must be received by SAMHSA not later than December 1 for a state or jurisdiction to receive its fiscal year 

SABG NoA. If a receipt date falls on a weekend or federal holiday, the receipt date for a report will be the next business day. The following 

schedule provides specific due dates for the SABG Annual Reports, MHBG Implementation Reports and the Annual Synar Reports: 

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. 
 

 

 

 

 

 

 

 

 

 

 

 

 

Due Dates for SA Only and MHBG/SABG Applications 

FY for which the state 

is applying for funds 

Application 

Due 

Plan 

Due 

Planning Period SABG Report 

Due 

Synar Report 

Due 

2022 9/1/2021 Yes 7/1/21 – 6/30/23 12/1/2021 

Compliance 

Year is 2019 

12/31/2021 

2023 9/1/2022 No N/A 12/1/2022 

Compliance 

Year is 2020 

12/31/2022 

Due Dates for Reports 

Applicable FY SABG Annual Report MHBG Implementation Report Annual Synar Report 

2022 12/01/2021 12/01/2021 12/31/2021 

2023 12/01/2022 12/01/2022 12/31/2022 

States are required to prepare and submit an annual report comprised of the following sections: 

Section B: Annual Update - In this section, states are required to provide a brief review of the extent to which their respective plans were 

implemented, and the progress toward the priorities and goals identified in the SABG plan covering SFY 2022 and 2023. The report should 

also include a brief review of areas that the state identified in that SABG plan as needing improvement and changes that the state or 

jurisdiction proposed to achieve the goals established for the priorities. 

Section C: State Agency Expenditure Reports - In this section, states must provide information regarding expenditures for authorized 

activities and services for primary substance use disorder prevention, substance use disorder2 (SUD) treatment, and recovery. The state must 

provide a description of SABG, COVID-19, and ARP Relief Supplement expenditures for authorized activities to prevent substance misuse 

and treat SUDs and related services for tuberculosis, and, if it is a “designated state,” a description of SABG and COVID-19 Relief 

Supplement expenditures for early intervention services for regarding the human immunodeficiency virus (EIS/HIV). 

Section D: Populations and Services Reports - In this section, states must provide specific information regarding the number of individuals 

served with SABG and COVID-19 Relief Supplement funds. In addition, states should provide specific information regarding the services 

these individuals received. 

2 The term “substance use disorder” means substance-related and addictive disorders as described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth 

Edition, Arlington, VA, American Psychiatric Association, 2013. 
 

 

 

 

 

 

 

 

Section E: Performance Indicators and Accomplishments - In this section of the report, states are required to complete the Performance 

Indicator tables. Performance indicators should be reported using the table format provided in this document. The purpose of the 

performance indicator tables is to show progress made over time as measured by SAMHSA’s National Outcome Measures (NOMS) for 

substance use disorder prevention, SUD treatment, and recovery. 

B. Annual Update 

The information states enter into SABG Table 1 in the planning section of the 2022/2023 Behavioral Health Assessment and Plan will 

automatically populate cells 1 - 6 in the progress report table below. States are required to indicate whether each first-year performance 

target/outcome measurement identified in 6.b below (from the 2022/2023 Plan) was “Achieved” or “Not Achieved” in cell 7, Report of 

Progress toward Goal Attainment. If a target was not achieved, a detailed explanation must be provided, along with remedial steps proposed 

to meet the target. 
 

 

 

SABG Table 1 - Priority Areas and Annual Performance Indicators – Progress Report 

Priority Areas and Annual Performance Indicators 

1. Priority Area: 

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

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

4. Goal of the Priority Area: 

5. Strategies to Attain the Goal: 

6. Annual Performance Indicators to Measure Goal Success: 

Indicator #1: 

a) Baseline measurement (Initial data collected prior to the first-year target/outcome): 

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

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

d) Data source: 

e) Description of data: 

f) Data issues/caveats that affect outcome measures: 

7. Report of Progress toward Goal Attainment: 

First-year target: ____ Achieved _____ Not Achieved (If not achieved, explain why.) 

Reason why target was not achieved and changes proposed to meet target: 

C. State Agency Expenditure Reports 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

States are required to provide information regarding SABG, COVID-19 Relief Supplement, American Rescue Plan (ARP), and state funds 

expended for authorized activities to prevent and treat SUDs and for related public health services, e.g., tuberculosis services (TB) and, if 

applicable, early intervention services regarding the human immunodeficiency virus (EIS/HIV), as well as expenditures for services to assist 

states in responding to the COVID-19 pandemic. Please complete the tables described below: 

SABG Table 2a - State Agency Expenditure Report. This table provides a report of SABG, Coronavirus Response and Relief Supplement 

Appropriations Act (COVID-19), 2021 [P.L. 116-260]), the American Rescue Plan Act (ARP), 2021 [P.L. 117-2] and state expenditures 

by the principal agency of a state, i.e., single state agency (SSA), during the state fiscal year immediately preceding the federal fiscal year 

for which the state is applying for funds. Expenditures to be reported are for authorized activities to prevent and treat SUDs pursuant to 

section 1921 of Title XIX, Part B, Subpart II of the Public Health Service (PHS) Act (42 U.S.C. § 300x-21); tuberculosis services; early 

intervention services regarding the human immunodeficiency virus (EIS/HIV), if applicable; pursuant to section 1924(b) of Title XIX, 

Part B, Subpart II of the PHS Act (42 U.S.C. § 300x-24(b)); and administration pursuant to section 1931(a)(2) of Title XIX, Part B, 

Subpart II of the PHS Act (42 U.S.C. § 300x-31(a)(2)). In column A, the applicable federal fiscal years’ SABG funds expended during 

the state fiscal year should be included. In column H, the applicable federal fiscal years COVID-19 Relief Supplement funds expended 

during the state fiscal year should be included. NOTE: For FY 2023 this table provides a report of expenditures from the SABG award, 

the COVID-19 Relief Supplement award, and the ARP Supplement award in column I. 

SABG Table 2b - COVID-19 Relief Supplement Funds Expenditure by Service. This table provides a report of COVID-19 Relief Supplement 

expenditures for services to assist states in responding to the COVID-19 pandemic. 

SABG Table 3a - Syringe Services Program. This table provides a report of SABG and COVID-19 Relief Supplement expenditures for 

elements of syringe services programs carried out by SABG sub-recipients as described in the guidance disseminated by the Office of 

HIV/AIDS and Infectious Disease Policy, the Centers for Disease Control and Prevention, National Center on HIV/AIDS, Viral Hepatitis, 

STD and TB Prevention, Division of HIV Prevention and SAMHSA. The authorization to expend federal funds for elements of a syringe 

services program is subject to an authorization in the annual appropriations’ bill(s). NOTE: For FY 2023 this table provides a report of 

expenditures from the COVID-19 Relief Supplement and ARP Supplement funding. 

SABG Table 3b - Expenditures for Syringe Services Programs (SSPs) Program Information. This table is intended to capture the 

unduplicated count of persons that received onsite services from an SSP or were referred to services by an SSP including HIV, Hepatitis 

C, and sexually transmitted disease testing, treatment for substance use conditions, and treatment for physical health. NOTE: For FY 

2023 this table provides a report of expenditures from the COVID-19 Relief Supplement and ARP Supplement funding. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SABG Table 4 - SABG State Agency Expenditure Compliance Report. This table provides a report of expenditures for authorized 

activities to prevent and treat SUDs associated with a SABG Notice of Award (NoA) for the applicable fiscal year. It covers the twoyear obligation and expenditure period. 

SABG Table 5a - SABG Primary Prevention Expenditures. This table provides a report of primary prevention expenditures associated with a 

SABG NoA for the applicable fiscal year. It covers the two-year obligation and expenditure period. Table 5a excludes Expenditures for 

Systems Development/Non-Direct Service Activities (formerly known as Resource Development Expenditures), which are located on SABG 

Table 6. 

SABG Table 5b - SABG Primary Prevention Targeted Priorities. This required table provides a report of actual state primary prevention 

priorities and special population categories on which the state expended primary prevention funds from the SABG NoA for the applicable 

fiscal year. 

SABG Table 6 - Expenditures for System Development/Non-Direct Service Activities. This table provides a report of expenditures from the 

SABG NoA for system development and non-direct service activities that were supported by the SABG NoA for the applicable fiscal year. 

SABG Table 7 - SABG Statewide Entity Inventory. This table provides a report of the SABG sub-recipients including community and faithbased organizations which provided SUD prevention activities and treatment services, along with intermediaries/administrative service 

organizations. Table 7 excludes Expenditures for Systems Development/Non-Direct Service Activities (formerly known as Resource 

Development Expenditures). 

SABG Table 8a - Maintenance of Effort for State Expenditures for Substance Abuse Prevention and Treatment. This table provides a report 

of aggregate state expenditures by the SSA for authorized activities to prevent and treat SUDs during the state fiscal year immediately 

preceding the federal fiscal year for which the state is applying for funds. 

SABG Table 8b - Base and Maintenance of Effort for Expenditures for Services to Pregnant Women and Women with Dependent Children. 

This table provides a report of SABG and/or state funds pursuant to 42 U.S.C. § 300x-22(b) and 45 CFR § 96.124(c)(3) expended to establish 

new programs or expand the capacity of existing programs designed to serve pregnant women and women with dependent children and the 

services required pursuant to 45 CFR § 96.124(e) to address the treatment and recovery needs of such women during the state fiscal year 

immediately preceding the federal fiscal year for which the state is applying for funds. 

SABG Table 2a - State Agency Expenditure Report 
 

 

 

 

 

 

 

 

 

 

–

This table provides a report of SABG and state expenditures by the SSA during the state fiscal year immediately preceding the federal fiscal year for 

which the state is applying for funds for authorized activities to prevent and treat SUDs. For detailed instructions, refer to those in the Block Grant 

Application System (BGAS). Please note that this expenditure period is different from that on SABG Table 4. 

State Agency Expenditure Report 

SABG Table 2a 

State Identifier: 

Report Period- From: To: 

(Include ONLY funds expended by the executive branch agency administering the Substance Abuse Block Grant) 

Source of Funds 

ACTIVITY 

(See instructions for using Row 

1) 

A. SABG B. MHBG C. Medicaid 

(Federal, 

State, and 

local) 

D. Other Federal Funds 

(e.g., ACF (TANF), CDC, 

CMS (Medicare) 

SAMHSA, etc.) 

E. State 

Funds 

F. Local 

Funds 

(excluding 

local 

Medicaid) 

G. Other H. 

COVID 

191 

I. ARP2 

1. Substance Abuse Prevention3 

(Other than Primary Prevention) 

and Treatment 

a. Pregnant Women and Women 

with Dependent Children 

b. All Other 

2. Primary Substance Use 

Disorder Prevention 

3. Tuberculosis Services 

4. Early Intervention Services 

Regarding the Human 

Immunodeficiency Virus 

(EIS/HIV)4 

5. Administration (Excluding 

Program and Provider Level) 

11. Total 
 

 

 

 

 

 

 

 

 

 

 

� �

1 The 24-month expenditure period for the COVID-19 Relief supplemental funding is March 15, 2021 – March 14, 2023, which is different from the expenditure period for the “standard” SABG 

and MHBG. Per the instructions, the standard SABG expenditures are for the state planned expenditure period of July 1, 2021 – June 30, 2023 for most states. 2 The expenditure period for The American Rescue Plan Act of 2021 (ARP) supplemental funding is September 1, 2021 – September 30, 2025, which is different from the expenditure period for 

the “standard” MHBG/SABG. Per the instructions, the planning period for standard MHBG/SABG expenditures is July 1, 2021 – June 30, 2023. 3 Prevention other than primary prevention 4 Only designated states as defined in 42 U.S.C. § 300x-24(b)(2) and 45 CFR § 96.128(b) for the applicable federal fiscal year should enter information in this row. This may include a 

state or states that were previously considered “designated states” during any of the three prior federal fiscal years for which a state was applying for a grant. See EIS/HIV policy change 

in SABG Annual Report instructions. 

Please indicate i f the expenditures are actual or estimated. 

� Actual �� Estimated 

0930-0168 Approved: 04/19/2019 Expires: 04/30/2022 

SABG Table 2b – COVID-19 Relief Funds Expenditure by Service 

Expenditure Period Start Date: Expenditure Period End Date: 

Service COVID-19 Expenditures 

Healthcare Home/Physical Health $ 

Specialized Outpatient Medical Services 

Acute Primary Care 

COVID-19 Screening (e.g., temperature checks, symptom questionnaires) 

COVID-19 Testing 

COVID-19 Vaccination 

Comprehensive Care Management 

Care Coordination and Health Promotion 

Comprehensive Transitional Care 

Individual and Family Support 

Referral to Community Services Dissemination 

Prevention (Including Promotion) 

Screening with Evidence-based Tools 

Risk Messaging 

Access Line/Crisis Phone Line/Warm Line 

Purchase of Technical Assistance 

COVID-19 Awareness and Education for Persons with SUD 
 

Service COVID-19 Expenditures 

Media Campaigns (Information Dissemination) 

Primary Substance Use Disorder Prevention (Education) 

Primary Substance Use Disorder Prevention (Alternatives) 

Employee Assistance Programs (Problem Identification and Referral) 

Primary Substance Use Disorder Prevention (Community-based Processes) 

Primary Substance Use Disorder Prevention (Environmental) 

Intervention Services 

Fentanyl Test Strips 

Syringe Services Program 

Naloxone 

Overdose Kits/Dissemination of Overdose Kits 

Engagement Services 

Assessment 

Specialized Evaluations (Psychological and Neurological) 

Services Planning (including crisis planning) 

Consumer/Family Education 

Outreach (including hiring of outreach workers) 

Outpatient Services 

Evidence-based Therapies 

Group Therapy 

Family Therapy 

Multi-family Therapy 

Consultation to Caregivers 

Medication Services 

Medication Management 

Pharmacotherapy (including MAT) 

Laboratory Services 

Community Support (Rehabilitative) 

Parent/Caregiver Support 

Case Management 
 

Service COVID-19 Expenditures 

Behavior Management 

Supported Employment 

Permanent Supported Housing 

Recovery Housing 

Recovery Supports 

Peer Support 

Recovery Support Coaching 

Recovery Support Center Services 

Supports for Self-Directed Care 

Supports (Habilitative) 

Personal Care 

Respite 

Supported Education 

Acute Intensive Services 

Mobile Crisis 

Peer-based Crisis Services 

Urgent Care 

23-hour Observation Bed 

Medically Monitored Intensive Inpatient for SUD 

24/7 Crisis Hotline 

Other 

Smartphone Apps 

Personal Protective Equipment 

Virtual/Telehealth/Telemedicine Services 

Purchase of increased connectivity (e.g., Wi-Fi) 

Cost-sharing Assistance (e.g., copayments, coinsurance, and deductibles) 

Provider Stabilization Payments 

Transportation to COVID-19 Services (e.g., testing, vaccination) 

Other (Please List) 
 

 

 

 

SABG Table 3 – Syringe Services Program 

Table 3 provides a report of SABG and state expenditures by the SSA during the state fiscal year immediately preceding the 

federal fiscal year for which the state is applying for funds for authorized activities to prevent and treat SUDs. For detailed 

instructions, refer to those in the Block Grant Application System (BGAS). 
 

 

 

 

Table 3a SABG – Syringe Services Program 

Report Period From: To: 

State Identifier 

Syringe Main Dollar Dollar Dollar SUD # of Narcan® Fentanyl 

Services Address of Amount of Amount of Amount of Treatment Locations Provided Test Strips 

Program SSP SABG Funds COVID-193 ARP4 Funds Provider (include any (Yes or No Provided 

(SSP) Expended for Funds Expended for (Yes or No) mobile (Yes or No) 

Agency SSP Expended for SSP locations) 

Name SSP 

0930-0168 Approved: 04/19/2019 Expires: 04/30/2022 

Footnotes: 
 

 

 

 

Table 3b SABG - Syringe Services Program 

SABG 

Syringe Services 

Program Name 

# of Unique 

Individuals Served 

HIV Testing 

(Please enter total 

number of 

individuals served) 

Treatment for 

Substance Use 

Conditions 

(Please enter total 

number of 

individuals served) 

Treatment for 

Physical Health 

(Please enter total 

number of 

individuals served) 

STD Testing 

(Please enter total 

number of 

individuals served) 

Hep C 

(Please enter total 

number of 

individuals served) 

ONSITEtestingREFERRAL totestingONSITEtreatmentREFERRAL totreatmentONSITEtreatmentREFERRAL totreatmentONSITE

testing

REFERRAL totestingONSITEtestingREFERRAL totesting 

COVID-19 

Syringe Services 

Program Name 

# of Unique 

Individuals Served 

HIV Testing 

(Please enter total 

number of 

individuals served) 

Treatment for 

Substance Use 

Conditions 

(Please enter total 

number of 

individuals served) 

Treatment for 

Physical Health 

(Please enter total 

number of 

individuals served) 

STD Testing 

(Please enter total 

number of 

individuals served) 

Hep C 

(Please enter total 

number of 

individuals served) 

ONSITEtestingREFERRAL totestingONSITEtreatmentREFERRAL totreatmentONSITEtreatmentREFERRAL totreatmentONSITE

testing

REFERRAL totestingONSITEtestingREFERRAL totesting 
 

 

 

 

 

Syringe Services 

Program Name 

# of Unique 

Individuals Served 

HIV Testing 

(Please enter total 

number of 

individuals served) 

Treatment for 

Substance Use 

Conditions 

(Please enter total 

number of 

individuals served) 

Treatment for 

Physical Health 

(Please enter total 

number of 

individuals served) 

STD Testing 

(Please enter total 

number of 

individuals served) 

Hep C 

(Please enter total 

number of 

individuals served) 

ONSITEtestingREFERRAL totestingONSITEtreatmentREFERRAL totreatmentONSITEtreatmentREFERRAL totreatmentONSITE

testing

REFERRAL totestingONSITEtestingREFERRAL totesting 

SABG Table 4 - State Agency SABG Expenditure Compliance Report 

This table provides a description of SABG expenditures for authorized activities to prevent and treat SUDs. For detailed instructions, refer to 

those in BGAS. Only one column is to be filled in each year. 

State Agency SABG Expenditure Compliance Report 

SABG Table 4 FY 2019 SA Block Grant 

Award 

FY 2020 SA Block Grant 

Award 

State Identifier: 

Expenditure Category 

1. Substance Abuse Prevention* and Treatment 

2. Primary Substance Use Disorder Prevention 

3. Early Intervention Services Regarding the Human Immunodeficiency Virus 

(EIS/HIV)** 

4. Tuberculosis Services 

5. Administration (excluding program / provider level) 

6. Total 

* Prevention other than Primary Prevention 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

** Only designated states as defined in 42 U.S.C. § 300x-24(b)(2) and 45 CFR § 96.128(b) for the applicable federal fiscal year should enter information in this 

row. This may include a state or states that were previously considered “designated states” during any of the three prior federal fiscal years for which a state 

was applying for a grant. See EIS/HIV policy change in SABG Annual Report instructions 

SABG Table 5a - Primary Prevention Expenditures 

The state or jurisdiction must complete SABG Table 5a. There are six primary prevention strategies typically funded by principal agencies 

administering the SABG. Expenditures within each of the six strategies or Institute of Medicine Model (IOM) should be directly associated 

with the cost of completing the activity or task. For example, information dissemination may include the cost of developing pamphlets, the 

time of participating staff and/or the cost of public service announcements, etc. If a state plans to use strategies not covered by these six 

categories or the state is unable to calculate expenditures by strategy, please report them under “Other” in Table 5a. 

The state or jurisdiction must complete SABG Table 5a Other Strategy if it chooses to report SUD primary prevention activities utilizing the 

IOM Model of Universal, Selective, and Indicated. Indicate how much funding supported each of the IOM classifications of Universal Direct, 

Universal Indirect, Selective, or Indicated without specifying the prevention strategy. Include all funding sources (e.g., Centers for Disease 

Control and Prevention Block Grant, foundations). For detailed instructions, refer to those in the Block Grant Application System (BGAS). 

Section 1926 (Synar) - Tobacco: Costs associated with the Synar Program. Pursuant to the January 19, 1996 federal regulation “Tobacco 

Regulation for Substance Abuse Prevention and Treatment Block Grants, Final Rule” (45 CFR § 96.130) a state may not use the SABG to 

fund the enforcement of its statute, except that it may expend funds from its primary prevention set aside of its 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. States should include any non-SABG funds* that were allotted for Synar activities in the appropriate columns 

under 7 below. Public Law 116-94, signed on December 20, 2019 supersedes this legislation and increased the minimum age for tobacco sales 

from 18 to 21. SAMHSA revised its guidance to clarify that the prevention set aside may be used to fund revisions to states’ Synar program to 

comply with PL 116-94. These funds should be reported in the appropriate columns under 7 below. 

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

Prevention. The one exception is if the state chooses to use a portion of the primary prevention set-aside to fund Non-Direct Services/System 

Development activities. The total on the Table 6 prevention column combined with the total on Table 5a should equal to expenditure Table 4, 

Row 2 in most instances. 

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

 

 

 

 

 

 

Prevention strategies may be classified using the IOM Model of Universal, Selective, and Indicated, which classifies preventive 

interventions by the population targeted. Definitions for these categories appear below: 

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

Universal Direct: Row 1 - Interventions directly serve an identifiable group of participants 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, Alcohol, 

Tobacco, and Other Drugs (ATOD) policies, modifying ATOD advertising practices). This also could include interventions involving 

programs and policies implemented by coalitions. 

Selective: Activities targeted to individuals or a subgroup of the population whose risk of developing a disorder is significantly higher than 

average. 

Indicated: Activities targeted to individuals in high-risk environments, identified as having minimal but detectable signs or symptoms 

foreshadowing disorder or having biological markers indicating predisposition for disorder but not meeting diagnostic levels (Adapted from 

The Institute of Medicine). 

States that can 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). 

Primary Substance Use Disorder Prevention Strategies Defined: 

Information Dissemination – This strategy provides knowledge and increases awareness of the nature and extent of alcohol and 

other drug use, abuse, and addiction, as well as their effects on individuals, families, and communities. It also provides 

knowledge and increases awareness of available prevention and treatment programs and services. It is characterized by one-way 

communication from the source to the audience, with limited contact between the two. 

Education - This strategy builds skills through structured learning processes. Critical life and social skills include decision 

making, peer resistance, coping with stress, problem solving, interpersonal communication, and systematic and judgmental 

abilities. There is more interaction between facilitators and participants than in the information strategy. 
 

 

 

 

 

Alternatives - This strategy provides participation in activities that exclude alcohol and other drugs. The purpose is to meet the 

needs filled by alcohol and other drugs with healthy activities and to discourage the use of alcohol and drugs through these 

activities. 

Problem Identification and Referral to Education - This strategy aims at identification of those who have indulged in 

illegal/age-inappropriate use of tobacco or alcohol and those individuals who have indulged in the first use of illicit drugs in order 

to assess if their behavior can be reversed through education. It should be noted, however, that this strategy does not include any 

activity designed to determine if a person needs treatment. 

Community-based Process - This strategy provides ongoing networking activities and technical assistance to community groups 

or agencies. It encompasses neighborhood-based, grassroots empowerment models using action planning and collaborative 

systems planning. 

Environmental - This strategy establishes or changes written and unwritten community standards, codes, and attitudes; thereby, 

influencing alcohol and other drug use by the general population. 

Other - States that plan their primary prevention expenditures using the IOM model of universal, selective, and indicated should 

use Table 5a to list their FFY 2022 and FFY 2023 SABG planned expenditures in each of these categories. 
 

 

 

 

 

-

SABG Primary Prevention Expenditures 

SABG Table 5a 

State Identifier: 

Report Period From: To: 

Strategy A. IOM Target B. SAPT Block Grant C. Other 

Federal D. State E. Local F. Other 

1. Information Dissemination Universal $ $ $ $ $ 

Selective $ $ $ $ $ 

Indicated $ $ $ $ $ 

Unspecified $ $ $ $ $ 

2. Education Universal $ $ $ $ $ 

Selective $ $ $ $ $ 

Indicated $ $ $ $ $ 

Unspecified $ $ $ $ $ 

3. Alternatives Universal $ $ $ $ $ 

Selective $ $ $ $ $ 

Indicated $ $ $ $ $ 

Unspecified $ $ $ $ $ 

4. Problem Identification and Referral Universal $ $ $ $ $ 

Selective $ $ $ $ $ 

Indicated $ $ $ $ $ 

Unspecified $ $ $ $ $ 

5. Community-Based Processes Universal $ $ $ $ $ 

Selective $ $ $ $ $ 

Indicated $ $ $ $ $ 

Unspecified $ $ $ $ $ 

6. Environmental Universal $ $ $ $ $ 

Selective $ $ $ $ $ 

Indicated $ $ $ $ $ 

Unspecified $ $ $ $ $ 

7. Section 1926 (Synar)-Tobacco Universal $ $ $ $ $ 

Selective $ $ $ $ $ 

Indicated $ $ $ $ $ 

8. Other Universal Direct $ $ $ $ $ 

Universal Indirect $ $ $ $ $ 

Selective $ $ $ $ $ 

Indicated $ $ $ $ $ 

10. Total $ $ $ $ $ 

*Please list all sources, if possible (e.g., Centers for Disease Control and Prevention, Block Grant, foundations, etc.) 
 

 

 

 

SABG Table 5b (Required) - SABG Primary Prevention Targeted Priorities 

The purpose of the first table is for the state or jurisdiction to identify the substance and/or categories of substances it identified through its 

needs assessment and then addressed with primary prevention set-aside dollars from the FY 2021 SABG NoA. The purpose of the second 

table is to identify each special population the state or jurisdiction selected as a priority for primary prevention set-aside expenditures. 

Targeted Substances SABG Award 

Alcohol ? 

Tobacco ? 

Marijuana ? 

Prescription Drugs ? 

Cocaine ? 

Heroin ? 

Inhalants ? 

Methamphetamine ? 

Synthetic Drugs (i.e. Bath salts, Spice, K2) ? 

Targeted Populations SABG Award 

Students in College ? 

Military Families ? 

LGBTQ+ ? 

American Indians/Alaska Natives ? 

African American ? 

Hispanic ? 

Homeless ? 

Native Hawaiian/Other Pacific Islanders ? 

Asian ? 

Rural ? 

Other Underserved Racial and Ethnic Minorities ? 

OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022 

Footnotes: 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

SABG/MHBG Table 6 - Non-Direct-Services/System Development 

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

Expenditures in the following categories of activities may involve the time of state or sub-state personnel, or may be funded through 

contracts, grants, or agreements with other entities. Expenditures may come from the administrative funds and/or program funds (but may not 

include the HIV set-aside funds). Please utilize the following categories to describe the types of expenditures your state supports with Block 

Grant 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 Block Grant 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 – the primary purpose is to assure the implementation of evidence based 

practices (EBP), so 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 to monitor 

performance and outcomes. Costs for electronic health records 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, re-entry follow-up), drop-in centers, and respite services. 

Partnerships, Community Outreach, and Needs Assessment – This includes state, regional, and local personnel salaries prorated for time 

and materials to support planning meetings, information collection, analysis, and travel. It also includes the support for partnerships across 

state and local agencies, and tribal governments. Community/network development activities, such as marketing, communication, and public 

education, and including the planning and coordination of services, fall into this category, as do needs-assessment projects to identify the 

scope and magnitude of the problem, resources available, gaps in services, and strategies to close those gaps. 

Planning Council Activities – This includes those supports for the performance of a Mental Health Planning Council under the MHBG, a 

combined Behavioral Health Planning Council, or (OPTIONAL) Advisory Council for the SABG. 

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 peer-review 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 Table 6 

State Identifier: 

Report Period From: To: 

Activity A. MHBG B. SABG 

Treatment 

C. SABG 

Prevention 

D. SABG Integrated * 

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 $ $ $ $ 

* Integrated refers to funds both treatment and prevention portions of the SABG for overarching activities. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

SABG Table 7 – State Entity Inventory 

This table provides a report of the sub-recipients of SABG funds including community and faith-based organizations which provided SUD 

prevention activities and treatment services, as well as intermediaries/administrative service organizations. Table 7 excludes system 

development/non-direct service expenditures. For detailed instructions, see those in BGAS. 

Statewide Entity Inventory 

SABG Table 7 

State Identifier: 

Report Period From: To: 

Source of Funds 

SAPT Block Grant 

A B B D E F 

Entity 

Number 

I-BHS ID 

(formerly 

I-SATS) 

Area 

Served 

(Statewide 

or SubState 

Planning 

Area) 

Provider/Program 

Name 

Street 

Address 

City State Zip All SA 

Block 

Grant 

Funds 

Prevention 

(other than 

Primary 

Prevention) 

and 

Treatment 

Services 

Pregnant 

Women 

and 

Women 

with 

Dependent 

Children 

Primary 

Prevention 

Early 

Intervention 

Services for HIV 

Syringe Services 

Program 

$ $ $ $ $ $ 

$ $ $ $ $ $ 

Total $ $ $ $ $ $ 

Description of Calculations for MOE Tables 8a and 8b 

Please provide a description of the amounts and methods used to calculate the following: 

(a) total Single State Agency (SSA) expenditures for SUD prevention and treatment as required by: 

a. 42 U.S.C. § 300x-30 and 45 CFR § 96.124(f)(4) 

(b) the base and, for 1994 and subsequent fiscal years, report the federal and state expenditures for services to pregnant women 

and women with dependent children as required by: 

b. 42 U.S.C. § 300x-22(b)(1) and 45 CFR § 96.122(f)(5)(ii)(A) 
 

 

 

 

 

 

 

-

SABG Table 8a - Maintenance of Effort for State Expenditures for SUD Prevention and Treatment 

This Maintenance of Effort table provides a description of non-federal expenditures for authorized activities to prevent and treat substance 

abuse flowing through the Single State Agency (SSA) during the state fiscal year immediately preceding the federal fiscal year for which the 

state is applying for funds. Dates given are for the FY 2022 SABG Report. For the FY 2023 SABG report, please increase each year by one. 

For detailed instructions, see those in BGAS. 

SABG Table 8a Total Single State Agency (SSA) Expenditures for Substance Abuse Prevention and 

Treatment 

State Identifier: 

Report Period From: To: 

Period 

(A) 

Expenditures 

(B) 

B1 (2018) + B2 (2019) 

2 

(C) 

SFY 2019 

(1) 

SFY 2020 

(2) 

SFY 2021 

(3) 

Are the expenditure amounts reported in Column B “actual” expenditures for the fiscal years involved? 

Yes No 

SFY 2019 

SFY 2020 

SFY 2021 

If any estimated expenditures are provided, please indicate when “actual” expenditure data will be submitted to SAMHSA: 

___/___/_____ 

mm/dd/yyyy 

Did the state or jurisdiction have any non-recurring expenditures as described in 42 U.S.C. § 300x-30(b) for a specific purpose which were 

not included in the MOE calculation? 

Yes____ No ___ If yes, specify the amount and the State fiscal year ___________ 

Did the state or jurisdiction include these funds in previous year MOE calculations? Yes___ No___ 
 

 

 

 

 

 

 

 

G Table 8c SABG Table 8c SABG Table 8c 

-

When did the State or Jurisdiction submit an official request to SAMHSA to exclude these funds from the MOE calculations? ___/___/_____ 

mm/dd/yyyy 

SABG Table 8b - Expenditures for Services to Pregnant Women and Women with Dependent Children 

This table provides a report of all statewide, non-federal funds expended on specialized treatment and related services which meet the SABG 

requirements for pregnant women and women with dependent children during the state fiscal year immediately preceding the federal fiscal 

year for which the state is applying for funds. Dates given are for the FY 2022 SABG Report. For the FY 2023 SABG Report, increase each 

year (other than the base year) by one. For detailed instructions, see those in BGAS. 

Expenditures for Services to Pregnant Women and Women with Dependent Children 

SABG Table 8b 

State Identifier: 

Report Period From: To: 

Period Total Women’s Base 

(A) 

Total Expenditures 

(B) 

1994 

2019 

2020 

2021 
 

 

 

 

 

 

 

 

 

 

 

 

 

D. Populations and Services Report 

States are required to provide information regarding individuals that are served by the SSA in SABG Tables 9 through 13. 

SABG Table 9 - Prevention Strategy Report. This table requires additional information (pursuant to Section 1929 of Title XIX, Part B, 

Subpart II of the PHS Act (42 U.S.C. § 300x-29) about the primary prevention activities conducted by the entities listed on SABG Table 7, 

State Entity Inventory, Column D. It seeks further information on the specific strategies and activities being funded by the principal agency of 

the state which address the sub-populations at risk for ATOD. 

SABG Table 10 - Treatment Utilization Matrix. This table is intended to capture the count of persons with initial admissions and subsequent 

admission(s) to an episode of care as defined in the Behavioral Health Services Information System (BHSIS), formerly known as the Drug 

and Alcohol Services Information System (DASIS), Treatment Episode Data Set (TEDS) standards (see TEDS data) during the state fiscal 

year immediately preceding the federal fiscal year for which the state is applying for funds. 

SABG Table 11a - Number of Persons Served (Unduplicated Count) for Alcohol and Other Drug Use. This table provides an aggregate 

profile of the unduplicated number of admissions and persons for services funded through the SABG during the state fiscal year immediately 

preceding the federal fiscal year for which the state is applying for funds. States are to provide this information on all programs by age, 

gender, and race/ethnicity. States are to report whether the values reported come from a client-based system(s) with unique client identifiers. 

SABG Table 11b - COVID-19 Number of Persons Served (Unduplicated Count) for Alcohol and Other Drug Use. This table provides an 

aggregate profile of the unduplicated number of admissions and persons for services funded with COVID-19 Relief Supplement funds during 

the state fiscal year immediately preceding the federal fiscal year for which the state is applying for funds. States are to provide this 

information on all programs by age, gender, and race/ethnicity. States are to report whether the values reported come from a client-based 

system(s) with unique client identifiers. 

SABG Table 11c - Sex, Sexual Orientation, and Gender Identity Number of Persons Served (Unduplicated Count) for Alcohol and Other 

Drug Use. This table provides an aggregate profile of the unduplicated number of admissions and persons for services funded through the 

SABG during the state fiscal year immediately preceding the federal fiscal year for which the state is applying for funds by sex, sexual 

orientation, and gender identity. States are to report whether the values reported come from a client-based system(s) with unique client 

identifiers. 

SABG Table 12 - SABG Designated States and Early Intervention Services Regarding the Human Immunodeficiency Virus. This table 

requires designated states as defined in section 1924(b)(2) of Title XIX, Part B, Subpart II of the PHS Act (42 U.S.C. § 300x-24(b)(2)), to 
 

 

 

 

 

 

 

provide information on Early Intervention Services Regarding the Human Immunodeficiency Virus (EIS/HIV) provided during the state fiscal 

year immediately preceding the federal fiscal year for which the state is applying for funds. 

SABG Table 13 - Charitable Choice. This table requires states to provide information regarding compliance with section 1955 of Title XIX, 

Part B, Subpart III of the PHS Act (42 U.S.C. § 300x-65) and the Charitable Choice Provisions and Regulations; Final Rule (42 CFR Part 54) 

during the state fiscal year immediately preceding the federal fiscal year for which the state is applying for funds. Each section of this table 

requires that the state respond appropriately to identify the way they have complied with the requirements related to authorizing legislation 

and implementing regulation. States should report on the number of clients referred due to religious objection from faith and communitybased programs to appropriate alternative providers. If no alternate referrals were made, enter zero. 
 

 

Column A (Risks) Column B (Strategies) Column C (Providers) 

Children of Substance Abusers [1] 

Pregnant Women/Teens [2] 

Drop-Outs [3] 

Violent and Delinquent Behavior [4] 

Mental Health Problems [5] 

Economically Disadvantaged [6] 

Physically Disabled [7] 

Abuse Victims [8] 

Already Using Substances [9] 

Homeless and/or Runaway Youth [10] 

Other- Specify [11] 

-

-

-

SABG Table 9 - Prevention Strategy Report 

This table requires additional information (pursuant to Section 1929 of Title XIX, Part B, Subpart II of the PHS Act (42 U.S.C.§ 300x 29) about 

the primary prevention activities conducted by the entities listed on SABG Table 7. For detailed instructions, see those in BGAS. 

Prevention Strategy Report Risk Strategies 

SABG Table 9 

Report Period From: To: 

State Identifier 
 

 

- -

SABG Table 10 – Treatment Utilization Matrix 

This table is intended to capture the count of persons with initial admissions and subsequent admission(s) to an episode of care. For detailed 

instructions, see those in BGAS. 

SABG Table 10 

Report Period 

From: 

To: 

Treatment Utilization Matrix 

SABG Number of 

Admissions ≥

Number of Persons 

Served 

COVID 19 Number of 

Admissions ≥ Number 

of Persons Served1 

ARP Number of 

Admissions ≥ Number

of Persons Served2 

SABG Costs per Person 

(C+D+E) 

COVID 19 Costs per Person 

(C+D+E)1 

ARP Costs per Person 

(C+D+E)2 

Level of Care Number of 

Admissions 

(A) 

Number 

of 

Persons 

Served 

(B) 

Number of 

Admissions 

(A) 

Number 

of 

Persons 

Served 

(B) 

Number of 

Admissions 

(A) 

Number 

of 

Persons 

Served 

(B) 

Mean 

Cost of 

Services 

(C) 

Median 

Cost of 

Services 

(D) 

Standard 

Deviation 

of Cost 

(E) 

Mean 

Cost of 

Services 

(C) 

Median 

Cost of 

Services 

(D) 

Standard 

Deviation 

of Cost 

(E) 

Mean 

Cost of 

Services 

(C) 

Median 

Cost of 

Services 

(D) 

Standard 

Deviation 

of Cost 

(E) 

Detoxification (24-Hour Care) 

1. Hospital 

Inpatient $ $ $ $ $ $ $ $ $ 

2. FreeStanding 

Residential $ $ $ $ $ $ $ $ $ 

Rehabilitation/Residential 

3. Hospital 

Inpatient $ $ $ $ $ $ $ $ $ 

4. Short-term 

(up to 30 

days) $ $ $ $ $ $ $ $ $ 

5. Long-term 

(over 30 days) $ $ $ $ $ $ $ $ $ 

Ambulatory (Outpatient) 

6. Outpatient $ $ $ $ $ $ $ $ $ 

7. Intensive 

Outpatient $ $ $ $ $ $ $ $ $ 

8. 

Detoxification $ $ $ $ $ $ $ $ $ 

Opioid Replacement Therapy3 

9. OUT 

MedicationAssisted 

Detoxification $ $ $ $ $ $ $ $ $ 

10. OUD 

MedicationAssisted 

Treatment 

Outpatient $ $ $ $ $ $ $ $ $ 
 

 

 

 

0930-0168 Approved: 04/19/2019 Expires: 04/30/2022 

1 The 24-month expenditure period for the COVID-19 Relief supplemental funding is March 15, 2021 – March 14, 2023, which is different from the expenditure period for the “standard” 

SABG and MHBG. Per the instructions, the standard SABG expenditures are for the state planned expenditure period of July 1, 2021 – June 30, 2023, for most states. 

2 The expenditure period for The American Rescue Plan Act of 2021 (ARP) supplemental funding is September 1, 2021 – September 30, 2025, which is different from the expenditure 

period for the “standard” MHBG/SABG. Per the instructions, the planning period for standard MHBG/SABG expenditures is July 1, 2021 – June 30, 2023. 

3 In FY 2020 SAMHSA modified the “Level of Care" (LOC)” and "Type of Treatment Service/Setting" to “Medication-Assisted Treatment” and “Medication- Assisted Treatment,” 

respectively. In prior SABG Reports, the LOC was entitled "Opioid Replacement Therapy" and the Type of Treatment Service/Setting included "Opioid Replacement Therapy," Row 9 

and "ORT Outpatient," Row 10. The changes inadvertently created a barrier for data analysis as one-to-one mapping of the data submitted in the FY 2020 Table 10 to the data submitted 

in prior Reports is not possible. In the current and future SABG Reports, the LOC is "OUD Medication Assisted Treatment" and the Types of Treatment Service/Setting will include 

"OUD Medication-Assisted Treatment Detoxification," Row 9 and "OUD Medication Assisted Treatment Outpatient," Row 10. OUD Medication Assisted Treatment Detoxification 

includes hospital detoxification, residential detoxification, or ambulatory detoxification services/settings AND Opioid Medication-Assisted Treatment. OUD Medication Assisted 

Treatment Outpatient includes outpatient services/settings AND Opioid Medication-Assisted Treatment. The change was made to better align with language that reflects not all 

medications used to treat opioid use disorder (OUD) are opioid-based and more importantly convey that medications do not merely substitute one drug for another. 
 

 

 

 

 

 

 

 

 

-

SABG Table 11a - Unduplicated Count of Persons Served for Alcohol and Other Drug Use 

This table provides an aggregate profile of the unduplicated number of admissions and persons for services funded through the SABG. For 

detailed instructions, see those in BGAS. 

Report Period From: To: 

State Identifier: 

Age A. Total B. White C. Black or 

African 

American 

D. Native 

Hawaiian/ 

Other Pacific 

Islander 

E. Asian F. American 

Indian/Alaska 

n Native 

G. More 

Than One 

Race 

Reported 

H. Unknown I. Not 

Hispanic or 

Latino 

J. Hispanic 

or Latino 

M F M F M F M F M F M F M F M F M F 

1. 17 and 

under 

2. 18-24 

3. 25-44 

4. 45-64 

5. 65 and 

over 

6. 

Total 

7. 

Pregnant 

Women 

Numbers of Persons 

Served who were 

admitted in a Period Prior 

to the 12-month reporting 

Period 

Number of persons 

served outside of the 

levels of care described 

on SABG Table 10 

Are the values reported in 

this table generated from 

a client-based system 

with unique client 

identifiers? 

Yes 

No 

0930-0168 Approved: 04/19/2019 Expires: 04/30/2022 
 

 

 

 

 

-

Table 11b- COVID-19 Number of Persons Served (Unduplicated Count) for Alcohol and Other Drug Use 

Report Period From: To: 

State Identifier: 

Age A. Total B. White C. Black or 

African 

American 

D. Native 

Hawaiian/ 

Other Pacific 

Islander 

E. Asian F. American 

Indian/Alaska 

n Native 

G. More 

Than One 

Race 

Reported 

H. Unknown I. Not 

Hispanic or 

Latino 

J. Hispanic 

or Latino 

M F M F M F M F M F M F M F M F M F 

1. 17 and 

under 

5. 18-24 

6. 25-44 

7. 45-64 

5. 65 and 

over 

6. 

Total 

7. 

Pregnant 

Women 
 

 

- - - -

-

TABLE 11c: Sex, Sexual Orientation, and Gender Identity Unduplicated Count of Persons Served for Alcohol and Other Drugs 

A. AGE B. 

Cisgender 

Male 

C. 

Cisgender 

Female 

D. 

Transgender 

Man 

/Transman 

/Female To 

Man 

E. 

Transgender 

Woman/ 

Transwoman/ 

Male To 

Female 

F. Genderqueer/ Gender 

Non Conforming/ 

Neither Exclusively Male 

nor Female 

G. Additional 

Gender Category 

(or Other) 

H. Straight 

or 

Heterosexual 

I. Gay or 

Lesbian 

J. 

Bisexual 

K. Queer, 

Pansexual, 

and/or 

Questioning 

L. Something 

Else? Please 

Specify 

17 and 

Under 

18-24 

25-44 

45-64 

65 and over 

TOTAL 
 

 

 

 

 

 

 

 

 

-

SABG Table 12 - SABG Early Intervention Services Regarding the Human Immunodeficiency Virus (EIS/HIV) in Designated States 

For detailed instructions, see those in BGAS. 

SABG Table 12 

Report Period From: To: 

State Identifier: 

Early Intervention Services Regarding the Human Immunodeficiency Virus (EIS/HIV) 

1. Number of EIS/HIV projects among SABG sub-recipients in the 

state: 

Statewide:_____ Rural:_____ 

2. Total number of individuals tested through SABG sub-recipient 

EIS/HIV projects: 

3. Total number of HIV tests conducted with SABG EIS/HIV funds: 

4. Total number of tests that were positive for HIV: 

5. Total number of individuals who prior to the 12-month reporting 

period were unaware of their HIV infection: 

6. Total number of HIV infected individuals who were diagnosed and 

referred into treatment and care during the 12-month reporting period 

Identify barriers, including state laws and regulations, that exist in carrying out HIV testing services: 
 

 

 

 

 

 

 

 

SABG Table 13 - Charitable Choice – Required 

Under Charitable Choice Provisions; Final Rule (42 CFR Part 54), states, local governments, and 

religious organizations, such as SAMHSA grant recipients, must: (1) ensure that religious 

organizations that are providers provide to all potential and actual program beneficiaries 

(services recipients) notice of their right to alternative services; (2) ensure that religious 

organizations that are providers refer program beneficiaries to alternative services; and (3) fund 

and/or provide alternative services. The term “alternative services” means services determined 

by the state to be accessible and comparable and provided within a reasonable period of time 

from another substance abuse provider (“alternative provider”) to which the program beneficiary 

(services recipient) has no religious objection. The purpose of this table is to document how the 

state is complying with these provisions. 

Notice to Program Beneficiaries – Check all that apply: 

□ Used model notice provided in final regulations. 

□ Used notice developed by state (please attach a copy to the Report). 

□ State has disseminated notice to religious organizations that are providers. 

□ State requires these religious organizations to give notice to all potential beneficiaries. 

Referrals to Alternative Services – Check all that apply: 

□ State has developed specific referral system for this requirement. 

□ State has incorporated this requirement into existing referral system(s). 

□ SAMHSA’s Behavioral Health Treatment Locator is used to help identify providers. 

□ Other networks and information systems are used to help identify providers. 

□ State maintains record of referrals made by religious organizations that are providers. 

Enter the total number of referrals to other substance abuse providers (“alternative 

providers”) necessitated by religious objection, as defined above, made during the 

state fiscal year immediately preceding the federal fiscal year for which the state is 

applying for funds. Provide the total only. No information on specific referrals is 

required. If no alternative referrals were made, enter zero. 

Provide a brief description (one paragraph) of any training for local governments and/or faithbased and/or community organizations that are providers on these requirements. 
 

 

 

 

 

 

 

 

 

E. Performance Data and Outcomes 

SAMHSA is interested in demonstrating program accountability and efficacy through the 

National Outcome Measures (NOMs). The NOMs are intended to document the performance of 

federally supported programs and systems of care. 

Treatment Performance Measures 

SABG Table 14 - Employment/Education Status. This table describes the status of adult clients 

served by the public SUD treatment service systems in terms of employment and education 

status. The Employment/Education Status Form seeks information on clients who are employed 

or who are students (full-time or part-time within the prior 30 days) at admission and discharge. 

SABG Table 15 - Stability of Housing. This table requests information regarding the number of 

individuals in a stable living environment as collected by the most recent assessment in the 

reporting period. Specifically, information is collected on the individual’s last known living 

situation. 

SABG Table 16 - Criminal Justice Involvement. This table requests information regarding the 

clients’ involvement in the criminal justice system. Specifically, the table requests information 

to measure the change in number of arrests over time. 

SABG Table 17 - Change in Abstinence - Alcohol Use. This table seeks information regarding 

alcohol abstinence. Specifically, information is collected on the number of clients with no 

alcohol use (all clients regardless of primary problem) at admission and discharge. 

SABG Table 18 - Change in Abstinence - Other Drug Use. This table collects information 

regarding clients’ change in abstinence with drugs of abuse other than alcohol. This table seeks 

to collect information on clients with no other drug use (all clients regardless of primary 

problem) at admission and discharge. 

SABG Table 19 - Change in Social Support of Recovery. This table seeks to measure the change 

in clients’ social support of recovery. Specifically, this form collects information regarding the 

number of clients participating in self-help groups at admission and discharge. 

SABG Table 20 - Retention. This table collects information regarding retention. Specifically, 

this table collects information regarding the length of stay of clients completing treatment. 
 

 

 

 

 

 

 

 

 

Prevention Performance Measures 

SABG Table 21 - Reduced Morbidity –Abstinence from Drug Use/Alcohol Use; Measure: 30 

Day Use. This table seeks information regarding 30-day use of alcohol, tobacco, and other 

drugs. 

SABG Table 22 - Reduced Morbidity –Abstinence from Drug Use/Alcohol Use; Measure: 

Perception of Risk/Harm of Use. This table seeks information regarding the individuals’ 

perceived risk of harming themselves with alcohol, tobacco, and other drugs. 

SABG Table 23 - Reduced Morbidity–Abstinence from Drug Use/Alcohol Use; Measure: Age of 

First Use. This table seeks information regarding the age of first use of alcohol, cigarettes, and 

other drugs. 

SABG Table 24 - Reduced Morbidity–Abstinence from Drug Use/Alcohol Use; Measure: 

Perception of Disapproval/Attitudes. This table seeks information regarding public perception or 

attitude regarding use of alcohol, cigarettes, and other drugs. 

SABG Table 25 - Employment/Education; Measure: Perception of Workplace Policy. This table 

reports the percent of individuals who would be more likely to work for an employer conducting 

random drug and alcohol tests. 

SABG Table 26 - Employment/Education; Measure: Average Daily School Attendance Rate. 

This table collects information regarding the average daily school attendance. 

SABG Table 27 - Crime and Criminal Justice; Measure: Alcohol-Related Traffic Fatalities. This 

table collects information regarding the number of alcohol-related traffic fatalities divided by the 

total number of traffic fatalities and multiplied by 100. 

SABG Table 28 - Crime and Criminal Justice; Measure: Alcohol and Drug Related Arrests. This 

table collects information regarding alcohol- and drug-related arrests. 

SABG Table 29 - Social Connectedness; Measure: Family Communications around Drug and 

Alcohol Use. This table provides information regarding the percent of youth reporting having 

talked with a parent and the percent of parents reporting that they have talked to their child about 

alcohol and drug use. 

SABG Table 30 - Retention; Measure: Percentage of Youth Seeing, Reading, Watching, or 

Listening to a Prevention Message. This table collects information regarding the percent of 

youth reporting having been exposed to prevention messaging. 

SABG Table 31-35 – Reporting Period – Start and End Dates for Information Reported on 

Tables 31, 32, 33, 34, and 35. This table provides information regarding the corresponding 

reporting period dates for Table 31 through Table 35. States also must describe their data 

collection system regarding prevention NOMS reporting. 

SABG Table 31 - Individual-Based Programs and Strategies; Measure: Number of Persons 

Served by Age, Gender, Race, and Ethnicity. This table provides information on the number of 

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persons served by individual-based programs and strategies. This includes practices and 

strategies with identifiable goals designed to change behavioral outcomes among a definable 

population or within a definable geographic area. 

SABG Table 32 - Population-Based Programs and Strategies; Measure: Number of Persons 

Served by Age, Gender, Race, and Ethnicity. This table provides information regarding the 

number of persons by age, gender, race, and ethnicity that participated in population-based 

programs. Population-based programs and strategies include planned and deliberate goaloriented practices, procedures, processes, or activities that have identifiable outcomes achieved 

with a sequence of steps subject to monitoring and modification. 

SABG Table 33 - Number of Persons Served by Type of Intervention. This table seeks to 

measure information on access and capacity of intervention programs. Specifically, this form 

collects information on the number of persons served by type of intervention. Interventions 

include activities, practices, procedures, processes, programs, services, and strategies. 

SABG Table 34 - Number of Evidence-Based Programs by Types of Intervention. This table 

collects information on the number of evidence-based programs and strategies by type of 

intervention. 

SABG Table 35 - Number of Evidence-based Programs and Strategies, and Total SABG Funds 

Spent on Evidence-Based Programs/ Strategies. This table collects information on the number 

of Evidence-Based Programs and Strategies funded by the type of Institute of Medicine (IOM) 

intervention (e.g. Universal, Selective, and Indicated). In addition, the state must indicate the 

amount of SABG funds spent on the Evidence-Based interventions. 

SABG Table 14 – Treatment Performance Measure: Employment /Education Status 

(From Admission to Discharge) 

Most recent year for which data are available: _____________ 

Employment/Education Status Clients employed or student 

(full time or part time) (prior 30 days) at admission vs. 

discharge 

Admission 

Clients (T1) 

Discharge 

Clients (T2) 

Number of clients employed or student (full-time and part-time) [numerator] 

Total number of clients with non-missing values on employment/student 

status [denominator] 

Percent of clients employed or student (full-time and part-time) 

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(SABG Table 14) (continued) State Description of Employment/Education Status Data Collection 

STATE CONFORMANCE 

TO INTERIM STANDARD 

DATA SOURCE 

EPISODE OF CARE 

DISCHARGE DATA 

COLLECTION 

RECORD LINKING 

IF DATA ARE 

UNAVAILABLE 

DATA PLANS IF DATA 

State Description of Employment/Education Data Collection (SABG Table 14): 

States should detail exactly how this information is collected. Where data and methods vary 

from interim standard, variance should be described. 

What is the source of data for SABG Table 14 (select all that apply): 

□ Client self-report □ Client self-report confirmed by another source→ □ collateral source □

Administrative data source □ Other Specify ___________________

How is the admission/discharge basis defined for SABG Table 14 (Select one) □ Admission is

on the first date of service, prior to which no service has been received for 30 days AND 

discharge is on the last date of service, subsequent to which no service has been received for 30 

days 

□ Admission is on the first date of service in a Program/Service Delivery Unit and Discharge

is on the last date of service in a Program/Service Delivery Unit 

□ Other Specify ___________________________________________ 

How was discharge data collected for SABG Table 14 (select all that apply) 

□ Not applicable, data reported on form is collected at time period other than discharge→

Specify: 

□ In-treatment data ___ days post-admission, OR □ Follow-up data ___ (specify) months 

Post- □ admission □ discharge □ other ______ 

□ Discharge data are collected for the census of all (or almost all) clients who were admitted 

to treatment □ Discharge data are collected for a sample or all clients who were admitted to 

treatment □ Discharge records are directly collected (or in the case of early dropouts) are 

created for all (or almost all) clients who were admitted to treatment 

□ Discharge records are not collected for approximately ___ % of clients who were admitted 

for treatment 

Was the admission and discharge data linked for table 14 (select all that apply): 

□ Yes, all clients at admission were linked with discharge data using a Unique Client 

Identifier (UCID) 

Select type of UCID □ Master Client Index or Master Patient Index, centrally assigned □

Social Security Number (SSN) □ Unique client ID based on fixed client characteristics (such

as date of birth, gender, partial SSN, etc.) □ Some other Statewide unique ID □ Providerentity-specific unique ID 

□ No, State Management Information System does not utilize UCID that allows comparison of

admission and discharge data on a client specific basis (data developed on a cohorts basis) or 

State relied on other data sources for post admission data □ No, admission and discharge

records were matched using probabilistic record matching. 

If data are not reported, why is State unable to report (select all that apply): 

□ Information is not collected at admission □ Information is not collected at discharge □

Information is not collected by the categories requested □ State collects information on the

indicator area but utilizes a different measure. 

State must provide time-framed plans for capturing employment\student status data on all 

clients if data are not currently available. Plans should also discuss barriers, resource needs 

and estimates of cost. 

SABG

ARE NOT AVAILABLE 

 Table 15 – Treatment Performance Measure: Stability of Housing 

(From Admission to Discharge) 

Most recent year for which data are available: _____________ 

Clients living in a stable living situation (prior 30 days) at admission vs. 

discharge 

Admission 

Clients (T1) 

Discharge 

Clients (T2) 

Number of clients living in a stable situation [numerator] 

Total number of clients with non-missing values on living arrangements [denominator] 

Percent of clients in a stable living situation 
 

If data are not reported, why is the state unable to report (select all that apply): □ Information

is not collected at admission □ Information is not collected at discharge □ Information is not

collected by the categories requested □ State collects information on the indicator area but

utilizes a different measure. 

 

 

 

 

 

 

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SABG Table 15 – State Description of Stability in Housing Data Collection 

DATA SOURCE 

EPISODE OF CARE 

DISCHARGE DATA 

COLLECTION 

RECORD LINKING 

IF DATA ARE 

UNAVAILABLE 

DATA PLANS IF DATA 

ARE NOT AVAILABLE 

STATE 

CONFORMANCE TO 

INTERIM STANDARD 

State Description of Stability in Housing Data Collection (SABG Table 15): 

States should detail exactly how this information is collected. Where data and methods vary 

from interim standard, variance should be described. 

What is the source of data for SABG Table 15 (select all that apply): 

□ Client self-report □ Client self-report confirmed by another source→ □ collateral source □

Administrative data source □ Other Specify ___________________

How is the admission/discharge basis defined for SABG Table 15 (Select one) □ Admission is

on the first date of service, prior to which no service has been received for 30 days AND 

discharge is on the last date of service, subsequent to which no service has been received for 30 

days 

□ Admission is on the first date of service in a Program/Service Delivery Unit and Discharge is

on the last date of service in a Program/Service Delivery Unit 

□ Other Specify ___________________________________________

_________________________________________________________ 

How was discharge data collected for SABG Table 15 (select all that apply) 

□ Not applicable, data reported on form is collected at time period other than discharge→

Specify: 

□ In-treatment data ___ days post-admission, OR □ Follow-up data ___ (specify) months Post- 

□ admission □ discharge □ other ______ 

□ Discharge data are collected for the census of all (or almost all) clients who were admitted to 

treatment □ Discharge data are collected for a sample or all clients who were admitted to 

treatment □ Discharge records are directly collected (or in the case of early dropouts) are 

created for all (or almost all) clients who were admitted to treatment 

□ Discharge records are not collected for approximately ___ % of clients who were admitted 

for treatment 

Was the admission and discharge data linked for SABG Table 15 (select all that apply): 

□ Yes, all clients at admission were linked with discharge data using a Unique Client Identifier 

(UCID) 

Select type of UCID □ Master Client Index or Master Patient Index, centrally assigned □

Social Security Number (SSN) □ Unique client ID based on fixed client characteristics (such as

date of birth, gender, partial SSN, etc.) □ Some other Statewide unique ID □ Provider-entityspecific unique ID 

□ No, State Management Information System does not utilize UCID that allows comparison of

admission and discharge data on a client specific basis (data developed on a cohorts basis) or 

State relied on other data sources for post admission data □ No, admission and discharge

records were matched using probabilistic record matching. 

State must provide time-framed plans for capturing criminal justice involvement status data on 

all clients if data are not currently available. Plans should also discuss barriers, resource needs 

and estimates of cost. 

SABG Table 16 – Treatment Performance Measure Criminal Justice Involvement 

(From Admission to Discharge) 

Most recent year for which data are available: _____________ 

Clients without arrests (any charge) (prior 30 days) at admission vs. discharge Admission 

Clients 

(T1) 

Discharge 

Clients 

(T2) 

Number of Clients without arrests [numerator] 

Total number of clients with non-missing values on arrests [denominator] 

Percent of clients without arrests 

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State Description of Criminal Involvement Data Collection (SABG Table 16) 

STATE 

CONFORMANCE TO 

INTERIM STANDARD 

DATA SOURCE 

EPISODE OF CARE 

DISCHARGE DATA 

COLLECTION 

RECORD LINKING 

IF DATA ARE 

UNAVAILABLE 

DATA PLANS IF DATA 

ARE NOT AVAILABLE 

State Description of Criminal Involvement Data Collection (SABG Table 16): 

States should detail exactly how this information is collected. Where data and methods vary 

from interim standard, variance should be described. 

What is the source of data for SABG Table 16 (select all that apply): 

□ Client self-report □ Client self-report confirmed by another source→ □ collateral source □

Administrative data source □ Other Specify ___________________

How is the admission/discharge basis defined for SABG Table 16 (Select one) □ Admission is 

on the first date of service, prior to which no service has been received for 30 days AND 

discharge is on the last date of service, subsequent to which no service has been received for 30 

days 

□ Admission is on the first date of service in a Program/Service Delivery Unit and Discharge is 

on the last date of service in a Program/Service Delivery Unit 

□ Other Specify ___________________________________________

How was discharge data collected for SABG Table 16 (select all that apply) 

□ Not applicable, data reported on form is collected at time period other than discharge→

Specify: 

□ In-treatment data ___ days post-admission, OR □ Follow-up data ___ (specify) months Post-

□ admission □ discharge □ other ______ 

□ Discharge data are collected for the census of all (or almost all) clients who were admitted to 

treatment □ Discharge data are collected for a sample or all clients who were admitted to 

treatment □ Discharge records are directly collected (or in the case of early dropouts) are 

created for all (or almost all) clients who were admitted to treatment 

□ Discharge records are not collected for approximately ___ % of clients who were admitted 

for treatment 

Was the admission and discharge data linked for SABG Table 16 (select all that apply): 

□ Yes, all clients at admission were linked with discharge data using a Unique Client Identifier 

(UCID) 

Select type of UCID □ Master Client Index or Master Patient Index, centrally assigned □

Social Security Number (SSN) □ Unique client ID based on fixed client characteristics (such as

date of birth, gender, partial SSN, etc.) □ Some other Statewide unique ID □ Provider-entityspecific unique ID 

□ No, State Management Information System does not utilize UCID that allows comparison of 

admission and discharge data on a client specific basis (data developed on a cohorts basis) or 

State relied on other data sources for post admission data □ No, admission and discharge

records were matched using probabilistic record matching. 

If data are not reported, why is State unable to report (select all that apply): □ Information is

not collected at admission □ Information is not collected at discharge □ Information is not

collected by the categories requested □ State collects information on the indicator area but

utilizes a different measure. 

State must provide time-framed plans for capturing criminal justice involvement status data on 

all clients if data are not currently available. Plans should also discuss barriers, resource needs 

and estimates of cost. 

SABG Table 17– Treatment Performance Measure: Change in Abstinence – Alcohol Use 

(From Admission to Discharge) 

Most recent year for which data are available: _____________ 

Alcohol Abstinence Clients with no alcohol use (all clients regardless of 

primary problem) (use Alcohol Use in last 30 days field) at admission vs. 

discharge. 

Admission 

Clients 

(T1) 

Discharge 

Clients 

(T2) 

Number of clients abstinent from alcohol [numerator] 

Total number of clients with non-missing values on “used any alcohol” variable [denominator] 

Percent of clients abstinent from alcohol 

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(1) If State does not have a "used any alcohol" variable, calculate instead using frequency of use 

variables for all primary, secondary, or tertiary problem codes in which the coded problem is Alcohol 

(e.g., TEDS Code 01) 

State Description of Alcohol Use Data Collection (SABG Table 17) 

STATE 

CONFORMANCE 

TO INTERIM 

STANDARD 

DATA SOURCE 

EPISODE OF 

CARE 

DISCHARGE 

DATA 

COLLECTION 

RECORD LINKING 

IF DATA ARE 

UNAVAILABLE 

DATA PLANS IF 

DATA ARE NOT 

AVAILABLE 

State Description of Alcohol Use Data Collection (SABG Table 17): 

State should detail exactly how this information is collected. Where data and methods vary 

from interim standard, variance should be described. 

What is the source of data for SABG Table 17 (select all that apply): 

□ Client self-report □ Client self-report confirmed by another source→ □ urinalysis, blood test

or other biological assay □ collateral source

□ Administrative data source □ Other Specify ___________________ 

How is the admission/discharge basis defined for SABG Table 17 (Select one) □ Admission is

on the first date of service, prior to which no service has been received for 30 days AND 

discharge is on the last date of service, subsequent to which no service has been received for 30 

days 

□ Admission is on the first date of service in a Program/Service Delivery Unit and Discharge is 

on the last date of service in a Program/Service Delivery Unit 

□ Other Specify ___________________________________________

How was discharge data collected for SABG Table 17 (select all that apply) 

□ Not applicable, data reported on form is collected at time period other than discharge→

Specify: 

□ In-treatment data ___ days post-admission, OR □ Follow-up data ___ (specify) months Post-

□ admission □ discharge □ other ______

□ Discharge data are collected for the census of all (or almost all) clients who were admitted to 

treatment □ Discharge data are collected for a sample or all clients who were admitted to 

treatment □ Discharge records are directly collected (or in the case of early dropouts) are 

created for all (or almost all) clients who were admitted to treatment 

□ Discharge records are not collected for approximately ___ % of clients who were admitted 

for treatment 

Was the admission and discharge data linked for SABG Table 17 (select all that apply): 

□ Yes, all clients at admission were linked with discharge data using a Unique Client Identifier 

(UCID) 

Select type of UCID □ Master Client Index or Master Patient Index, centrally assigned □

Social Security Number (SSN) □ Unique client ID based on fixed client characteristics (such as

date of birth, gender, partial SSN, etc.) □ Some other Statewide unique ID □ Provider-entityspecific unique ID 

□ No, State Management Information System does not utilize UCID that allows comparison of

admission and discharge data on a client specific basis (data developed on a cohorts basis) or 

State relied on other data sources for post admission data □ No, admission and discharge

records were matched using probabilistic record matching. 

If data are not reported, why is State unable to report (select all that apply): □ Information is

not collected at admission □ Information is not collected at discharge □ Information is not

collected by the categories requested □ State collects information on the indicator area but

utilizes a different measure. 

State must provide time-framed plans for capturing abstinence - alcohol use status data on all 

clients if data are not currently available. Plans should also discuss barriers, resource needs and 

estimates of cost. 

SABG Table 18 – Performance Measure: Change in Abstinence – Other Drug Use (From 

Admission to Discharge) Most recent year for which data are available: _____________ 

Drug Abstinence Clients with no drug use (all clients regardless of primary 

problem) (use Any Drug Use in last 30 days field) at admission vs. discharge. 

Admission 

Clients (T1) 

Discharge 

Clients (T2) 

Number of Clients abstinent from illegal drugs [numerator] 

Total number of clients with non-missing values on “used any drug” variable [denominator] * 

Percent of clients abstinent from drugs 

*If State does not have a "used any drug" variable, calculate instead using frequency of use variables for all primary, secondary, or tertiary 

problem codes in which the coded problem is drugs (e.g., TEDS Codes 01-04) 

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SABG Table 18 – State Description of Other Drug Use Data Collection 

STATE 

CONFORMANCE TO 

INTERIM STANDARD 

DATA SOURCE 

EPISODE OF CARE 

DISCHARGE DATA 

COLLECTION 

RECORD LINKING 

IF DATA ARE 

UNAVAILABLE 

DATA PLANS IF DATA 

ARE NOT AVAILABLE 

State Description of Other Drug Use Data Collection (SABG Table 18): 

States should detail exactly how this information is collected. Where data and methods vary 

from interim standard, variance should be described. 

What is the source of data for SABG Table 18 (select all that apply): 

□ Client self-report □ Client self-report confirmed by another source→ □ urinalysis, blood test

or other biological assay □ collateral source

□ Administrative data source □ Other Specify ___________________

How is the admission/discharge basis defined for SABG Table 18 (Select one) □ Admission is

on the first date of service, prior to which no service has been received for 30 days AND 

discharge is on the last date of service, subsequent to which no service has been received for 30 

days 

□ Admission is on the first date of service in a Program/Service Delivery Unit and Discharge is

on the last date of service in a Program/Service Delivery Unit 

□ Other Specify ___________________________________________

How was discharge data collected for SABG Table 18 (select all that apply) 

□ Not applicable, data reported on form is collected at time period other than discharge→

Specify: 

□ In-treatment data ___ days post-admission, OR □ Follow-up data ___ (specify) months Post-

□ admission □ discharge □ other ______ 

□ Discharge data are collected for the census of all (or almost all) clients who were admitted to 

treatment □ Discharge data are collected for a sample or all clients who were admitted to 

treatment □ Discharge records are directly collected (or in the case of early dropouts) are 

created for all (or almost all) clients who were admitted to treatment 

□ Discharge records are not collected for approximately ___ % of clients who were admitted 

for treatment 

Was the admission and discharge data linked for SABG Table 18 (select all that apply): 

□ Yes, all clients at admission were linked with discharge data using a Unique Client Identifier 

(UCID) 

Select type of UCID □ Master Client Index or Master Patient Index, centrally assigned □

Social Security Number (SSN) □ Unique client ID based on fixed client characteristics (such as

date of birth, gender, partial SSN, etc.) □ Some other Statewide unique ID □ Provider-entityspecific unique ID 

□ No, State Management Information System does not utilize UCID that allows comparison of

admission and discharge data on a client specific basis (data developed on a cohorts basis) or 

State relied on other data sources for post admission data □ No, admission and discharge 

records were matched using probabilistic record matching. 

If data are not reported, why is State unable to report (select all that apply): □ Information is

not collected at admission □ Information is not collected at discharge □ Information is not

collected by the categories requested □ State collects information on the indicator area but

utilizes a different measure. 

State must provide time-framed plans for capturing abstinence – drug use status data on all 

clients if data are not currently available. Plans should also discuss barriers, resource needs and 

estimates of cost. 

SABG Table 19 – Performance Measure: Change in Social Support of Recovery 

(From Admission to Discharge) 

Most recent year for which data are available: _____________ 

Social Support of Recovery Clients participating in self help 

groups (e.g., AA, NA, etc.) (prior 30 days) at admission vs. discharge 

Admission 

Clients 

(T1) 

Discharge 

Clients 

(T2) 

Number of clients participating in self-help (AA NA meetings attended, etc.) 

[numerator] 

Total number of Admission and Discharge clients with non-missing values on selfhelp activities [denominator] 

Percent of clients participating in self-help activities 

SABG Table 19 – State Description of Social Support of Recovery Data Collection 

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STATE 

CONFORMANCE TO 

INTERIM STANDARD 

DATA SOURCE 

EPISODE OF CARE 

DISCHARGE DATA 

COLLECTION 

RECORD LINKING 

IF DATA ARE 

UNAVAILABLE 

DATA PLANS IF DATA 

ARE NOT AVAILABLE 

State Description of Social Support of Recovery Data Collection (SABG Table 19): 

States should detail exactly how this information is collected. Where data and methods vary from 

interim standard, variance should be described. 

What is the source of data for SABG Table 19 (select all that apply): 

□ Client self-report □ Client self-report confirmed by another source→

□ collateral source □ Administrative data source

□ Other Specify ___________________

How is the admission/discharge basis defined for SABG Table 19 (Select one) □ Admission is on the 

first date of service, prior to which no service has been received for 30 days AND discharge is on the 

last date of service, subsequent to which no service has been received for 30 days 

□ Admission is on the first date of service in a Program/Service Delivery Unit and Discharge is on the 

last date of service in a Program/Service Delivery Unit 

□ Other Specify ___________________________________________

How was discharge data collected for SABG Table 19 (select all that apply) 

□ Not applicable, data reported on form is collected at time period other than discharge→ Specify:

□ In-treatment data ___ days post-admission, OR □ Follow-up data ___ (specify) months Post- □ 

admission □ discharge □ other ______ 

□ Discharge data are collected for the census of all (or almost all) clients who were admitted to 

treatment □ Discharge data are collected for a sample or all clients who were admitted to treatment □

Discharge records are directly collected (or in the case of early dropouts) are created for all (or almost 

all) clients who were admitted to treatment 

□ Discharge records are not collected for approximately ___ % of clients who were admitted for 

treatment 

Was the admission and discharge data linked for SABG Table 19 (select all that apply): 

□ Yes, all clients at admission were linked with discharge data using a Unique Client Identifier 

(UCID) 

Select type of UCID □ Master Client Index or Master Patient Index, centrally assigned □ Social

Security Number (SSN) □ Unique client ID based on fixed client characteristics (such as date of birth,

gender, partial SSN, etc.) □ Some other Statewide unique ID □ Provider-entity-specific unique ID 

□ No, State Management Information System does not utilize UCID that allows comparison of

admission and discharge data on a client specific basis (data developed on a cohorts basis) or State 

relied on other data sources for post admission data □ No, admission and discharge records were 

matched using probabilistic record matching. 

If data are not reported, why is State unable to report (select all that apply): □ Information is not 

collected at admission □ Information is not collected at discharge □ Information is not collected by 

the categories requested □ State collects information on the indicator area but utilizes a different

measure. 

State must provide time-framed plans for capturing self-help participation status data on all clients if 

data are not currently available. Plans should also discuss barriers, resource needs and estimates of 

cost. 

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SABG Table 20 – Retention; Length of Stay (in Days) of Clients Completing Treatment 

Most recent year for which data are available: _____________ 

LENGTH OF STAY 

Level of Care Average 

(Mean) 

Median Interquartile Range 

Detoxification (24 hour care) 

1. Hospital Inpatient 

2. Free-Standing 

Residential 

Rehabilitation/Residential 

3. Hospital Inpatient 

4. Short-term 

(up to 30 days) 

5. Long-term 

(over 30 days) 

Ambulatory (Outpatient) 

6. Outpatient 

7. Intensive Outpatient 

8. Detoxification 

Opioid Replacement Therapy 

9. ORT Detox 

10. Opioid Replacement 

Therapy 

Section V: Performance Indicators and Accomplishments 

Tables 21 – 36: Prevention Performance Measures 

Tables 21 – 30: Prevention Performance Measures 

Introduction: 

The National Outcome Measures (NOMs) are a set of domains and measures that the Substance 

Abuse and Mental Health Services Administration (SAMHSA) uses to accomplish its vision and 

to meet all of its federal reporting requirements, thus reducing burden and redundancy for 

grantees. 

The NOMs Data Collection and Reporting tables are to be completed as part of the state's annual 

SABG application. For Tables 21-25 and 27-30, the compliance year is calendar year (CY) 2019 

(note that pre-populated NOMs from the National Survey on Drug Use and Health (NSDUH) 

reflect pooled data from CYs 2018-2019. For substance abuse prevention NOMs Table 26, the 

compliance year is School Year 2019. 

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For purposes of this section, unless otherwise noted, the term "state" refers to states, territories, 

and the one Native American tribe that receive SABG funding. 

Tables 21 through 30 - Information 

A. Pre-populated Data 

CSAP and the states have agreed that the state-level reporting requirement for the NOMs listed 

in Tables 21-30 will be fulfilled through the use of extant data from sources including the 

National Survey on Drug Use and Health (NSDUH), the Fatality Analysis Reporting System 

(FARS) of the National Highway Traffic Safety Administration, the Uniform Crime Report 

(UCR) of the Federal Bureau of Investigation, and the National Center for Education Statistics 

(NCES) of the U.S. Department of Education. These pre-populated state-level NOMs will meet 

most of the state-level NOMs reporting requirements for the prevention portion of the SABG 

funding. These data will be pre-populated into the data tables by CSAP. 

NOMs Domain - Reduced Morbidity Abstinence from Drug Use/Alcohol Use 

• Table 21: 30-Day Use 

• Table 22: Perception of Risk/Harm of Use 

• Table 23: Age of First Use 

• Table 24: Perception of Disapproval/Attitudes 

NOMs Domain - Employment/Education 

• Table 25: Perception of Workplace Policy 

• Table 26: Average Daily School Attendance Rate 

NOMs Domain - Crime and Criminal Justice 

• Table 27: Alcohol-Related Traffic Fatalities 

• Table 28: Alcohol- and Drug-Related Arrests 

NOMs Domain - Social Connectedness 

• Table 29: Family Communications Around Drug and Alcohol Use 

NOMs Domain - Retention 

• Table 30: Youth Seeing, Reading, Watching, or Listening to a Prevention Message 

In this block grant application pre-populated data are automatically provided to fulfill the 

majority of the reporting requirements. 

Territories and Native American tribes for which there are no NSDUH, FARS, UCR, and/or 

NCES data will not be required to report on those measures, but will be encouraged to provide 

substitute data in Column D. 

B. Supplemental Data 

States may also wish to provide additional data related to the NOMs. The data can be included 

in the block grant appendix. When describing the supplemental data, states should provide any 

relevant Web addresses (URLs) that provide links to specific state data sources. 

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D. Instructions for Completing Forms 

Column A: Measure - The SAMHSA defined measure for the domain listed. 

Column B: Question/Response 

• Source Survey Item: For Tables 21-25, 29, and 30, the source is the NSDUH. For Tables 26-28 

other "archival" sources are identified. The specific language used for each item is provided. 

• Response Option: The range of responses that are provided for the survey item. 

• Outcome Reported: The specific responses that are included in the calculation provided for the 

item. 

• Age: The age range for which the responses are provided. 

Column C: Pre-populated Data - Pre-populated data are provided; see letter A, Pre-populated 

data. 

Column D: Approved Substitute Data – Grantees for which there are no NSDUH, FARS, 

UCR and/or NCES data will be able to voluntarily enter data for the items in this column. 

Substitute data are not allowed for grantees with pre-populated data. 

SAGB Table 21 – Primary Substance Abuse Use Disorder Prevention NOMs Domain: 

Reduced Morbidity – Abstinence from Drug Use/Alcohol Use 

Measure: 30-Day Use 

A. 

Measure 

B. 

Question/Response 

C. 

Pre 

populated 

Data 

D. 

Supplemental 

Data, if any 

1. 30-day 

Alcohol Use 

Source Survey Item: NSDUH Questionnaire. “Think specifically about 

the past 30 days, that is, from [DATEFILL] through today. During the 

past 30 days, on how many days did you drink one or more drinks of an 

alcoholic beverage?” [Response option: Write in a number between 0 and 

30.] 

Outcome Reported: Percent who reported having used alcohol during 

the past 30 days. 

Ages 12–20 – CY 2018-2019 

Ages 21+ - CY 2018-2019 

2. 30-day 

Cigarette Use 

Source Survey Item: NSDUH Questionnaire: “During the past 30 days, 

that is, since [DATEFILL], on how many days did you smoke part or all 

of a cigarette?” [Response option: Write in a number between 0 and 30.] 

Outcome Reported: Percent who reported having smoked a cigarette 

during the past 30 days. 

Ages 12–17 - CY 2018-2019 

Ages 18+ - CY 2018-2019 

3. 30-day Use 

of Other 

Tobacco 

Products 

Source Survey Item: NSDUH Questionnaire: “During the past 30 days, 

that is, since [DATEFILL], on how many days did you use [other 

tobacco products]†

?” [Response option: Write in a number between 0 and 

30.] 

Outcome Reported: Percent who reported having used a tobacco 

product other than cigarettes during the past 30 days, calculated by 

combining responses to questions about individual tobacco products 

(cigars, smokeless tobacco, pipe tobacco). 

Ages 12–17 - CY 2018-2019 

Ages 18+ - CY 2018-2019 

49 
 

 

 

 

 

 

 

 

 

 

-

DO NOT DISTRIBUTE – CLOSE HOLD 

A. 

Measure 

B. 

Question/Response 

C. 

Pre 

populated 

Data 

D. 

Supplemental 

Data, if any 

4. 30-day Use 

of Marijuana 

Source Survey Item: NSDUH Questionnaire: “Think specifically about 

the past 30 days, from [DATEFILL] up to and including today. During 

the past 30 days, on how many days did you use marijuana or hashish?” 

[Response option: Write in a number between 0 and 30.] 

Outcome Reported: Percent who reported having used marijuana or 

hashish during the past 30 days. 

Ages 12–17 - CY 2018-2019 

Ages 18+ - CY 2018-2019 

5. 30-day Use 

of Illicit Drugs 

Other Than 

Marijuana 

Source Survey Item: NSDUH Questionnaire: “Think specifically about 

the past 30 days, from [DATEFILL] up to and including today. During 

the past 30 days, on how many days did you use [any other illegal 

drug]‡

?” 

Outcome Reported: Percent who reported having used illegal drugs 

other than marijuana or hashish during the past 30 days, calculated by 

combining responses to questions about individual drugs (heroin, cocaine, 

hallucinogens, inhalants, methamphetamine, and misuse of prescription 

drugs). 

Ages 12–17 - CY 2018-2019 

Ages 18+ - CY 2018-2019 

† NSDUH asks separate questions for each tobacco product. The number provided combines responses to all questions about tobacco 

products other than cigarettes.

‡ NSDUH asks separate questions for each illegal drug. The number provided combines responses to all questions about illegal drugs other 

than marijuana or hashish. 

50 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

-

SAGB Table 22 – Primary Substance Abuse Use Disorder Prevention NOMs Domain: 

Reduced Morbidity – Abstinence from Drug Use/Alcohol Use 

Measure: Perception of Risk/Harm of Use 

A. 

Measure 

B. 

Question/Response 

C. 

Pre 

populated 

Data 

D. 

Supplemental 

Data if any 

1. Perception of 

Risk from 

Alcohol 

Source Survey Item: NSDUH Questionnaire: “How much do people 

risk harming themselves physically and in other ways when they have 

five or more drinks of an alcoholic beverage once or twice a week?” 

[Response options: No risk, slight risk, moderate risk, great risk] 

Outcome Reported: Percent reporting moderate or great risk. 

Ages 12–20 - CY 2018-2019 

Ages 21+ - CY 2018-2019 

2. Perception of 

Risk from 

Cigarettes 

Source Survey Item: NSDUH Questionnaire: “How much do people 

risk harming themselves physically and in other ways when they smoke 

one or more packs of cigarettes per day?” [Response options: No risk, 

slight risk, moderate risk, great risk] 

Outcome Reported: Percent reporting moderate or great risk. 

Ages 12–17 - CY 2018-2019 

Ages 18+ - CY 2018-2019 

3. Perception of 

Risk from 

Marijuana 

Source Survey Item: NSDUH Questionnaire: “How much do people 

risk harming themselves physically and in other ways when they smoke 

marijuana once or twice a week?” [Response options: No risk, slight risk, 

moderate risk, great risk] 

Outcome Reported: Percent reporting moderate or great risk. 

Ages 12–17 - CY 2018-2019 

Ages 18+ - CY 2018-2019 

SAGB Table 23 – Primary Substance Abuse Use Disorder Prevention NOMs Domain: 

Reduced Morbidity – Abstinence from Drug Use/Alcohol Use 

Measure: Age of First Use 

A. 

Measure 

B. 

Question/Response 

C. 

Pre 

populated 

Data 

D. 

Supplemental 

Data if any 

1. Age at First 

Use of Alcohol 

Source Survey Item: NSDUH Questionnaire: “Think about the first 

time you had a drink of an alcoholic beverage. How old were you the 

first time you had a drink of an alcoholic beverage? Please do not 

include any time when you only had a sip or two from a drink.” 

[Response option: Write in age at first use.] 

Outcome Reported: Average age at first use of alcohol. 

Ages 12–20 - CY 2018-2019 

Ages 21+ - CY 2018-2019 

2. Age at First 

Use of Cigarettes 

Source Survey Item: NSDUH Questionnaire: “How old were you the 

first time you smoked part or all of a cigarette?” [Response option: 

Write in age at first use.] 

Outcome Reported: Average age at first use of cigarettes. 

Ages 12–17 - CY 2018-2019 

Ages 18+ - CY 2018-2019 

3. Age at First 

Use of Tobacco 

Products Other 

Than Cigarettes 

Source Survey Item: NSDUH Questionnaire: “How old were you the 

first time you used [any other tobacco product]†?” [Response option: 

Write in age at first use.] 

Outcome Reported: Average age at first use of tobacco products other 

than cigarettes. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

-

A. 

Measure 

B. 

Question/Response 

C. 

Pre 

populated 

Data 

D. 

Supplemental 

Data if any 

Ages 12–17 - CY 2018-2019 

Ages 18+ CY 2018-2019 

4. Age at First 

Use of Marijuana 

or Hashish 

Source Survey Item: NSDUH Questionnaire: “How old were you the 

first time you used marijuana or hashish?” [Response option: Write in 

age at first use.] 

Outcome Reported: Average age at first use of marijuana or hashish. 

Ages 12–17 - CY 2018-2019 

Ages 18+ - CY 2018-2019 

5. Age at First 

Use of Heroin 

Source Survey Item: NSDUH Questionnaire: “How old were you the 

first time you used heroin?” [Response option: Write in age at first use.] 

Outcome Reported: Average age at first use of heroin. 

Ages 12–17 - CY 2018-2019 

Ages 18+ - CY 2018-2019 

6. Age at First 

Misuse of 

Prescription Pain 

Relievers Among 

Past Year 

Initiates 

Source Survey Item: NSDUH Questionnaire: “How old were you the 

first time you used [specific pain reliever]

‡ in a way a doctor did not 

direct you to use it?” [Response option: Write in age at first use.] 

Outcome Reported: Average age at first misuse of prescription pain 

relievers among those who first misused prescription pain relievers in 

the last 12 months. 

Ages 12–17 - CY 2018-2019 

Ages 18+ - CY 2018-2019 

† The question was asked about each tobacco product separately, and the youngest age at first use was taken as the measure. 

‡ The question was asked about each drug in this category separately, and the youngest age at first use was taken as the measure. 

SABG Table 24 – Primary Substance Abuse Use Disorder Prevention NOMs Domain: 

Reduced Morbidity – Abstinence from Drug Use/Alcohol Use 

Measure: Perception of Disapproval/Attitudes 

A. 

Measure 

B. 

Question/Response 

C. 

Pre 

populated 

Data 

D. 

Supplemental 

Data if any 

1. Disapproval of 

Cigarettes 

Source Survey Item: NSDUH Questionnaire: “How do you feel about 

someone your age smoking one or more packs of cigarettes a day?” 

[Response options: Neither approve nor disapprove, somewhat 

disapprove, strongly disapprove] 

Outcome Reported: Percent somewhat or strongly disapproving. 

Ages 12–17 - CY 2018-2019 

2. Perception of 

Peer Disapproval 

of Cigarettes 

Source Survey Item: NSDUH Questionnaire: “How do you think your 

close friends would feel about you smoking one or more packs of 

cigarettes a day?” [Response options: Neither approve nor disapprove, 

somewhat disapprove, strongly disapprove] 

Outcome Reported: Percent reporting that their friends would 

somewhat or strongly disapprove. 

Ages 12–17 - CY 2018-2019 

3. Disapproval of 

Using Marijuana 

Experimentally 

Source Survey Item: NSDUH Questionnaire: “How do you feel about 

someone your age trying marijuana or hashish once or twice?” 

[Response options: Neither approve nor disapprove, somewhat 

disapprove, strongly disapprove] 

Outcome Reported: Percent somewhat or strongly disapproving. 

Ages 12–17 - CY 2018-2019 

52 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

-

-

A. 

Measure 

B. 

Question/Response 

C. 

Pre 

populated 

Data 

D. 

Supplemental 

Data if any 

4. Disapproval of 

Using Marijuana 

Regularly 

Source Survey Item: NSDUH Questionnaire: “How do you feel about 

someone your age using marijuana once a month or more?” [Response 

options: Neither approve nor disapprove, somewhat disapprove, 

strongly disapprove] 

Outcome Reported: Percent somewhat or strongly disapproving. 

Ages 12–17 - CY 2018-2019 

5. Disapproval of 

Alcohol 

Source Survey Item: NSDUH Questionnaire: “How do you feel about 

someone your age having one or two drinks of an alcoholic beverage 

nearly every day?” [Response options: Neither approve nor disapprove, 

somewhat disapprove, strongly disapprove] 

Outcome Reported: Percent somewhat or strongly disapproving. 

Ages 12–20 - CY 2018-2019 

SAGB Table 25 – Primary Substance Abuse Use Disorder Prevention NOMs Domain: 

Reduced Morbidity – Abstinence from Drug Use/Alcohol Use 

Measure: Perception of Workplace Policy 

A. 

Measure 

B. 

Question/Response 

C. 

Pre 

populated 

Data 

D. 

Supplemen 

tal Data, if 

any 

Perception of 

Workplace 

Policy 

Source Survey Item: NSDUH Questionnaire: “Would you be more or less likely to 

want to work for an employer that tests its employees for drug or alcohol use on a 

random basis? Would you say more likely, less likely, or would it make no 

difference to you?” [Response options: More likely, less likely, would make no 

difference] 

Outcome Reported: Percent reporting that they would be more likely to work for 

an employer conducting random drug and alcohol tests. 

Ages 15–17 - CY 2018-2019 

Ages 18+ - CY 2018-2019 

SAGB Table 26 – Primary Substance Abuse Use Disorder Prevention NOMs Domain: 

Reduced Morbidity – Abstinence from Drug Use/Alcohol Use 

Measure: Average Daily School Attendance Rate 

A. 

Measure 

B. 

Source 

C. 

Pre 

populated 

Data 

D. 

Supplemen 

tal Data, if 

any 

Average Daily 

School 

Attendance 

Rate 

Source: National Center for Education Statistics, Common Core of Data: The 

National Public Education Finance Survey available for download at 

http://nces.ed.gov/ccd/stfis.asp 

Measure calculation: Average daily attendance (NCES defined) divided by total 

enrollment and multiplied by 100. 

CY 2019 

53 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

-

SAGB Table 27 – Primary Substance Abuse Use Disorder Prevention NOMs Domain: Crime 

and Criminal Justice 

Measure: Alcohol Related Fatalities 

A. 

Measure 

B. 

Source 

C. 

Pre 

populated 

Data 

D. 

Supplemental 

Data if any 

Alcohol-Related 

Traffic Fatalities 

Source: National Highway Traffic Safety Administration Fatality 

Analysis Reporting System 

Measure calculation: The number of alcohol-related traffic fatalities 

divided by the total number of traffic fatalities and multiplied by 100. 

CY 2019 

SAGB Table 28 – Primary Substance Abuse Use Disorder Prevention NOMs Domain: Crime 

and Criminal Justice 

Measure: Alcohol and Drug-Related Arrests 

A. 

Measure 

B. 

Source 

C. 

Pre 

populated 

Data 

D. 

Supplemental 

Data if any 

Alcohol- and 

Drug-Related 

Arrests 

Source: Federal Bureau of Investigation Uniform Crime Reports 

Measure calculation: The number of alcohol- and drug-related arrests 

divided by the total number of arrests and multiplied by 100. 

CY 2019 

SAGB Table 29 – Primary Substance Abuse Use Disorder Prevention NOMs Domain: 

Social Connectedness 

Measure: Family Communications Around Drug and Alcohol Use 

A. 

Measure 

B. 

Question/Response 

C. 

Prepopulated 

Data 

D. 

Supplemental 

Data if any 

1. Family 

Communications 

Around Drug and 

Alcohol Use 

(Youth) 

Source Survey Item: NSDUH Questionnaire: “Now think about the 

past 12 months, that is, from [DATEFILL] through today. During 

the past 12 months, have you talked with at least one of your parents 

about the dangers of tobacco, alcohol, or drug use? By parents, we 

mean either your biological parents, adoptive parents, stepparents, or 

adult guardians, whether or not they live with you.” [Response 

options: Yes, No] 

Outcome Reported: Percent reporting having talked with a parent. 

Ages 12–17 - CY 2018-2019 

2. Family 

Communications 

Around Drug and 

Source Survey Item: NSDUH Questionnaire: “During the past 12 

months, how many times have you talked with your child about the 

dangers or problems associated with the use of tobacco, alcohol, or 

54 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

A. 

Measure 

B. 

Question/Response 

C. 

Prepopulated 

Data 

D. 

Supplemental 

Data if any 

Alcohol Use 

(Parents of children 

aged 12–17) 

other drugs?”† [Response options: 0 times, 1 to 2 times, a few times, 

many times] 

Outcome Reported: Percent of parents reporting that they have 

talked to their child. 

Ages 18+ - CY 2018-2019 

† NSDUH does not ask this question of all sampled parents. It is a validation question posed to parents of 12- to 17-year-old survey 

respondents. Therefore, the responses are not representative of the population of parents in a State. The sample sizes are often too small 

for valid reporting. 

SAGB Table 30 – Primary Substance Abuse Use Disorder Prevention NOMs Domain: 

Retention 

Measure: Percentage of Youth Seeing, or Listening to a Prevention Message 

Measure Question/Response Pre 

populated 

Data 

Supplemental 

Data if any 

Exposure to 

Prevention 

Messages 

Source Survey Item: NSDUH Questionnaire: “During the past 12 

months, do you recall [hearing, reading, or watching an advertisement 

about the prevention of substance use]†

?” 

Outcome Reported: Percent reporting having been exposed to 

prevention message. 

Ages 12–17 - CY 2018-2019 

† This is a summary of four separate NSDUH questions each asking about a specific type of prevention message delivered within a 

specific context 

SABG Tables 31-35 – Reporting Period 

Start and End Dates for Information Reported on SABG Tables 31, 32, 33, 34, and 35. 

The following chart is for collecting information on the reporting periods for the data entered in 

Tables 31-35. Please note that the correct reporting period for Tables 31-34 is the Calendar 

Year (CY) which coincides with the reporting period for the pre-populated prevention 

NOMs in Tables 21-30. We understand that some states have reported on the state fiscal 

year (SFY) or federal fiscal year (FFY) for these tables in past SABG Reports. If your state 

is unable to report on the calendar year, please indicate in this footnote why you are unable 

to report on the calendar year and the steps the state intends to take to make calendar year 

reporting possible in future years. Note that the correct reporting period for Table 35 is 

the SABG compliance period that coincides with the reporting period for Tables 4, 5a, 5b, 6 

and 7. 

Rows 1 through 5 each correspond to a single form in the current year application among the 

following five tables: 31, 32, 33, 34 and 35. 

Column A: Enter the reporting period start date. 

Column B: Enter the reporting period end date. 

The date format to be entered in columns A and B should be month/day/year, as follows. 

• Month: enter 2 digits (e.g. January = 01; December = 12) 

• Day: enter 2 digits (e.g. 1st of the month = 01; 15th of the month = 15) 

55 
 

 

 

• Year: enter all 4 digits (e.g. 2012, 2013) 

Reporting Period Start and End Dates for Information Reported on 

SABG Tables 31, 32, 33, 34 and 35 

Please indicate the reporting period for each of the following NOMS. 

Tables A. Reporting Period 

Start Date 

B. Reporting Period 

End Date 

1. SABG Table 31 

Individual-Based Programs and Strategies – 

Number of Persons Served by Age, Gender, Race, 

and Ethnicity 

mm/dd/yyyy mm/dd/yyyy 

2. SABG Table 32 

Population-Based Programs and Strategies – 

Number of Persons Served by Age, Gender, Race, 

and Ethnicity 

mm/dd/yyyy mm/dd/yyyy 

3. SABG Table 33 (Optional) 

Number of Persons Served by Type of 

Intervention 

mm/dd/yyyy mm/dd/yyyy 

4. SABG Table 34 

Number of Evidence-Based Programs and 

Strategies by Type of Intervention 

mm/dd/yyyy mm/dd/yyyy 

5. SABG Table 35 

Total Number of Evidence-Based Programs and 

Total SABG Dollars Spent on Evidence-Based 

Programs/Strategies 

mm/dd/yyyy mm/dd/yyyy 

General Questions Regarding Prevention NOMS Reporting 

Question 1: Describe the data collection system you used to collect the NOMs data (e.g., MDS, 

DbB, KIT Solutions, manual process). 

Question 2: Describe how your State’s data collection and reporting processes record a 

participant’s race, specifically for participants who are more than one race. 

Indicate whether the State added those participants to the number for each applicable racial 

category or whether the State added all those participants to the More Than One Race 

subcategory. 

56 
 

 

 

SABG Table 31 – Primary Substance Use Disorder Prevention Individual-Based Programs 

and Strategies – Number of Persons Served by Age, Gender, Race, and Ethnicity 

Category Total 

A. Age 

0–4 

5–11 

12–14 

15–17 

18–20 

21–24 

25–44 

45–64 

65 and Over 

Age Not Known 

B. Gender 

Male 

Female 

Gender Not Known 

C. Ethnicity 

Hispanic or Latino 

Not Hispanic or Latino 

Ethnicity Unknown 

D. Race 

White 

Black or African American 

Native Hawaiian/Other Pacific Islander 

Asian 

American Indian/Alaska Native 

More Than One Race (not OMB required) 

Race Not Known or Other (not OMB required) 

57 
 

 

 

 

 

- -

- -

SABG Table 32 – Primary Substance Use Disorder Prevention Population-Based Programs 

and Strategies – Number of Persons Served by Age, Gender, Race, and Ethnicity 

Category Total 

A. Age 

0–4 

5–11 

12–14 

15–17 

18–20 

21–24 

25–44 

45–64 

65 and Over 

Age Not Known 

B. Gender 

Male 

Female 

Gender Not Known 

C. Race 

White 

Black or African American 

Native Hawaiian/Other Pacific Islander 

Asian 

American Indian/Alaska Native 

More Than One Race (not OMB required) 

Race Not Known or Other (not OMB required) 

D. Ethnicity 

Hispanic or Latino 

Not Hispanic or Latino 

Ethnicity unknown 

SABG Table 33 (Optional) – Primary Substance Use Disorder Prevention Number of 

Persons Served by Type of Intervention 

Intervention Type 

Number of Persons Served by Individual or Population Based 

Program or Strategy 

A. 

Individual Based 

Programs and Strategies 

B. 

Population Based Programs 

and Strategies 

1. Universal Direct 

2. Universal Indirect 

3. Selective 

4. Indicated 

5. Total 

58 
 

 

 

 

SABG Table 34 – Primary Substance Use Disorder Prevention 

Evidence-Based Programs and Strategies by Type of Intervention 

Definition of Evidence-Based Programs and Strategies: The guidance document for the 

Strategic Prevention Framework State Incentive Grant, Identifying and Selection Evidence-based 

Interventions, provides the following definition for evidence-based programs: 

• Inclusion in a Federal List or Registry of evidence-based interventions 

• Being Reported (with positive effects) in a peer-reviewed journal 

• Documentation of effectiveness based on the following guidelines: 

o Guideline 1: The intervention is based on a theory of change that is documented 

in a clear logic or conceptual model; and 

o Guideline 2: The intervention is similar in content and structure to interventions 

that appear in registries and/or the peer-reviewed literature; and 

o Guideline 3: The intervention is supported by documentation that it has been 

effectively implemented in the past, and multiple times, in a manner attentive to 

Identifying and Selecting Evidence-Based Interventions scientific standards of 

evidence and with results that show a consistent pattern of credible and positive 

effects; and 

o Guideline 4: The intervention is reviewed and deemed appropriate by a panel of 

informed prevention experts that includes: well-qualified prevention researchers 

who are experienced in evaluating prevention interventions similar to those under 

review; local prevention practitioners; and key community leaders as appropriate, 

e.g., officials from law enforcement and education sectors or elders within 

indigenous cultures. 

1. Describe the process the state will use to implement the guidelines included in the above 

definition. 

2. Describe how the state collected data on the number of programs and strategies. What is 

the source of the data? 

59 
 

 

 

 

 

 

 

-

-

SABG Table 34 – Primary Substance Use Disorder Prevention Number of Evidence-Based 

Programs and Strategies by Type of Intervention 

Number of Programs and Strategies by Type of Intervention 

A. 

Universal 

Direct 

B. 

Universal 

Indirect 

C. 

Universal 

Total 

D. 

Selective 

E. 

Indicated 

F. 

Total 

1. Number of Evidence-Based 

Programs and Strategies Funded 

2. Total number of Programs and 

Strategies Funded 

3. Percent of Evidence-Based 

Programs and Strategies 

SABG Table 35 – Total Primary Substance Use Disorder Prevention Number of Evidence 

Based Programs/Strategies and Total SABG Dollars Spent on Primary Substance Use 

Disorder Prevention Evidence-Based Programs/Strategies 

Total Number of Evidence Based 

Programs/Strategies for IOM Category below: 

Total SAPT Block Grant $Dollars Spent on 

evidence based Programs/Strategies 

Universal Direct Total # $ 

Universal Indirect Total # $ 

Selective Total # $ 

Indicated Total # $ 

Unspecified Total# $ 

Total EBPs: Total Dollars Spent: $ 

60