ࡱ> 6I/012345 =bjbjWW {.554^  T%d%t%t%t%$%%%P%T<)t%=(- 7F888P9 pXT`,'''''''$7+-'t%dP9P9dd't%t%88H'&h&h&hdt%8t%8'&hd'&h&hLh8P%Ue\' (0=( .g:. hh .t%t4!dd&hddddd''&hddd=(dddd.ddddddddd  $: Department of Health and Human Services Substance Abuse and Mental Health Services Administration Now is the Time Healthy Transitions (HT): Improving Life Trajectories for Youth and Young Adults with, or at Risk for, Serious Mental Health Conditions Short Title: NITT-Healthy Transitions (NITT-HT) (Initial Announcement) Request for Applications (RFA) No. SM-14-017 Catalogue of Federal Domestic Assistance (CFDA) No.: 93.243 Key Dates: Application DeadlineApplications are due by June 13, 2014.  Table of Contents  TOC \o "1-2" \h \z \u  HYPERLINK \l "_Toc384922609" EXECUTIVE SUMMARY  PAGEREF _Toc384922609 \h 4  HYPERLINK \l "_Toc384922610" I. FUNDING OPPORTUNITY DESCRIPTION  PAGEREF _Toc384922610 \h 6  HYPERLINK \l "_Toc384922611" 1. PURPOSE  PAGEREF _Toc384922611 \h 6  HYPERLINK \l "_Toc384922612" 2. EXPECTATIONS  PAGEREF _Toc384922612 \h 8  HYPERLINK \l "_Toc384922613" II. AWARD INFORMATION  PAGEREF _Toc384922613 \h 19  HYPERLINK \l "_Toc384922614" III. ELIGIBILITY INFORMATION  PAGEREF _Toc384922614 \h 20  HYPERLINK \l "_Toc384922615" 1. ELIGIBLE APPLICANTS  PAGEREF _Toc384922615 \h 20  HYPERLINK \l "_Toc384922616" 2. COST SHARING and MATCH REQUIREMENTS  PAGEREF _Toc384922616 \h 20  HYPERLINK \l "_Toc384922617" 3. OTHER  PAGEREF _Toc384922617 \h 20  HYPERLINK \l "_Toc384922618" IV. APPLICATION AND SUBMISSION INFORMATION  PAGEREF _Toc384922618 \h 22  HYPERLINK \l "_Toc384922619" 1. CONTENT AND GRANT APPLICATION SUBMISSION  PAGEREF _Toc384922619 \h 22  HYPERLINK \l "_Toc384922620" 2. APPLICATION SUBMISSION REQUIREMENTS  PAGEREF _Toc384922620 \h 26  HYPERLINK \l "_Toc384922621" 4. FUNDING LIMITATIONS/RESTRICTIONS  PAGEREF _Toc384922621 \h 26  HYPERLINK \l "_Toc384922622" V. APPLICATION REVIEW INFORMATION  PAGEREF _Toc384922622 \h 27  HYPERLINK \l "_Toc384922623" 1. EVALUATION CRITERIA  PAGEREF _Toc384922623 \h 27  HYPERLINK \l "_Toc384922624" 2. REVIEW AND SELECTION PROCESS  PAGEREF _Toc384922624 \h 32  HYPERLINK \l "_Toc384922625" VI. ADMINISTRATION INFORMATION  PAGEREF _Toc384922625 \h 33  HYPERLINK \l "_Toc384922626" 1. AWARD NOTICES  PAGEREF _Toc384922626 \h 33  HYPERLINK \l "_Toc384922627" 2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS  PAGEREF _Toc384922627 \h 33  HYPERLINK \l "_Toc384922628" 3. REPORTING REQUIREMENTS  PAGEREF _Toc384922628 \h 34  HYPERLINK \l "_Toc384922629" VII. AGENCY CONTACTS  PAGEREF _Toc384922629 \h 34  HYPERLINK \l "_Toc384922630" Appendix A Checklist for Formatting Requirements and Screen-out Criteria for SAMHSA Grant Applications  PAGEREF _Toc384922630 \h 36  HYPERLINK \l "_Toc384922631" Appendix B Guidance for Electronic Submission of Applications  PAGEREF _Toc384922631 \h 38  HYPERLINK \l "_Toc384922632" Appendix C Using Evidence-Based Practices (EBPs)  PAGEREF _Toc384922632 \h 45  HYPERLINK \l "_Toc384922633" Appendix D Statement of Assurance  PAGEREF _Toc384922633 \h 47  HYPERLINK \l "_Toc384922634" Appendix E Funding Restrictions  PAGEREF _Toc384922634 \h 49  HYPERLINK \l "_Toc384922635" Appendix F Biographical Sketches and Job Descriptions  PAGEREF _Toc384922635 \h 51  HYPERLINK \l "_Toc384922636" Appendix G Sample Budget and Justification (no match required)  PAGEREF _Toc384922636 \h 52  HYPERLINK \l "_Toc384922637" Appendix H Confidentiality and SAMHSA Participant Protection/Human Subjects Guidelines  PAGEREF _Toc384922637 \h 62  HYPERLINK \l "_Toc384922638" Appendix I Addressing Behavioral Health Disparities  PAGEREF _Toc384922638 \h 67  HYPERLINK \l "_Toc384922639" Appendix J Electronic Health Record (EHR) Resources  PAGEREF _Toc384922639 \h 72  EXECUTIVE SUMMARY In support of the Presidents Now is the Time (NITT) Plan, the Substance Abuse and Mental Health Services Administration (SAMHSA) is announcing a new grant program, Now is the Time Healthy Transitions: Improving Life Trajectories for Youth and Young Adults with, or at Risk for, Serious Mental Health Conditions (Short Title, NITT-Healthy Transitions (NITT-HT). The purpose of this program is to improve access to treatment and support services for youth and young adults ages 16 25 that either have, or are at risk of developing a serious mental health condition. Individuals who are 16 25 years old are at high risk of developing a mental illness or substance use disorder, and are at high risk for suicide. Unfortunately, these youth are among the least likely to seek help and, as a result, they may fall through the cracks and not receive the help they need to assume safe and productive adult roles and responsibilities. The Presidents Plan can be found at:  HYPERLINK "http://www.whitehouse.gov/sites/default/files/docs/wh_now_is_the_time_full.pdf" http://www.whitehouse.gov/sites/default/files/docs/wh_now_is_the_time_full.pdf Youth and young adults with serious mental health conditions or co-occurring mental and substance use disorders face an even more difficult transition to adulthood than their peers. As a result, it is important to identify these young people, develop appropriate outreach and engagement processes and create access to effective clinical and supportive interventions. Outreach and engagement is essential to these youth and young adults, 16 25, and their families, as many of them are disconnected from social and other community supports. These youth may not be working, in school, or in vocational or higher education programs. Some face the additional challenge of being homeless, or having contact with the juvenile or criminal justice system, increasing the likelihood of admissions to hospitals, mental health facilities and correctional facilities. Once identified and engaged, it becomes essential to improve emotional and behavioral functioning so that youth and young adults can progress into adult roles and responsibilities and lead full and productive lives. Funding Opportunity Title:Healthy Transitions (HT)Funding Opportunity Number:SM-14-017Due Date for Applications:June 13, 2014Anticipated Total Available Funding:15,840,000Estimated Number of Awards:16Estimated Award Amount:Up to 1,000,000 per yearCost Sharing/Match RequiredNoLength of Project Period:Up to 5 years Eligible Applicants:Eligible applicants are State governments and federally recognized American Indian/Alaska Native (AI/AN) Tribes and Tribal organizations. [See  HYPERLINK \l "_1._ELIGIBLE_APPLICANTS" Section III-1 of this RFA for complete eligibility information.] I. FUNDING OPPORTUNITY DESCRIPTION 1. PURPOSE In support of the Presidents Now is the Time (NITT) Plan, the Substance Abuse and Mental Health Services Administration (SAMHSA) is announcing a new grant program, Now is the Time Healthy Transitions: Improving Life Trajectories for Youth and Young Adults with, or at Risk for, Serious Mental Health Conditions (Short Title, NITT-Healthy Transitions (NITT-HT). The purpose of this program is to improve access to treatment and support services for youth and young adults ages 16 25 that either have, or are at risk of developing a serious mental health condition. Individuals who are 16 25 years old are at high risk of developing a mental illness or substance use disorder, and are at high risk for suicide. Unfortunately, these youth are among the least likely to seek help and, as a result, they may fall through the cracks and not receive the help they need to assume safe and productive adult roles and responsibilities. The Presidents Plan can be found at:  HYPERLINK "http://www.whitehouse.gov/sites/default/files/docs/wh_now_is_the_time_full.pdf" http://www.whitehouse.gov/sites/default/files/docs/wh_now_is_the_time_full.pdf Youth and young adults with serious mental health conditions or co-occurring mental and substance use disorders face an even more difficult transition to adulthood than their peers. As a result, it is important to identify these young people, develop appropriate outreach and engagement processes and create access to effective clinical and supportive interventions. Outreach and engagement is essential to these youth and young adults, 16 25, and their families, as many of them are disconnected from social and other community supports. These youth may not be working, in school, or in vocational or higher education programs. Some face the additional challenge of being homeless, or having contact with the juvenile or criminal justice system, increasing the likelihood of admissions to hospitals, mental health facilities and correctional facilities. Once identified and engaged, it becomes essential to improve emotional and behavioral functioning so that youth and young adults can progress into adult roles and responsibilities and lead full and productive lives. As part of the Presidents overall NITT initiative, SAMHSA will create a continuum of outreach, engagement, awareness, prevention and intervention strategies. This continuum includes Project AWARE at the front end, which will focus on prevention and promotion with school age youth in educational settings, and Healthy Transitions (HT), which will extend this focus by creating treatment services and intervention approaches for disconnected youth and young adults that are transitioning to adulthood. The overall goal of HT will be to provide services and supports to address serious mental health conditions, co-occurring disorders, and risk for developing serious mental health conditions among youth 16 25 years old. This will be accomplished by increasing awareness, screening and detection, outreach and engagement, referrals to treatment, coordination of care and evidence-informed treatment for this age group. Healthy Transitions will: increase awareness about early indications of signs and symptoms for serious mental health concerns; identify action strategies to use when a serious mental health concern is detected; provide training to provider and community groups to improve services and supports specific to this age group; enhance peer and family supports, and develop effective services and interventions for youth, young adults and their families as these young people transition to adult roles and responsibilities. When needed, these services are to be continuous so that young people and their families experience a seamless transition across age groups. The Healthy Transitions program envisions three populations of focus: 16 25 year olds at risk of developing a serious mental health condition who may otherwise be unidentified; 16 25 year olds who have already been identified as experiencing a serious mental health condition; and the community-at-large (i.e., general public). For youth at risk, Healthy Transitions will focus on outreach and engagement strategies, including the use of peer-to-peer and family supports, social media, and coordination across care delivery systems, including vocational training and higher education. These strategies will connect young people to resources to help them maintain their health and develop skills to lead full, productive lives. Outreach and engagement will also create opportunities for early detection and intervention for those who begin to exhibit more serious problems over time. And, for youth with existing mental health conditions, including those experiencing early signs of serious mental illness, Healthy Transitions will improve access to relevant child- or adult-serving systems and implement effective evidence-based services and supports to improve outcomes and life trajectories. For the general public, this initiative will raise awareness about the early indications of serious mental health and substance use conditions among youth and young adults and identify action strategies to use when a serious mental health concern is identified for youth and young adults. The critical point of focus is to increase outreach efforts to identify youth and young adults who either have untreated mental health conditions or are at risk of developing such conditions; with a goal of keeping young people from falling through the cracks, especially after they leave high school. This will be expected to occur at the state/tribal/territorial level and at the local level. These outreach efforts will involve raising awareness through social media and other existing natural networks, (e.g. YMCAs, health fairs, primary care centers, faith organizations and teen centers) that can effectively target youth, family, and community members about the early warning signs of mental illness and action steps to identify needed resources, expanding access to care. It is anticipated that youth and family organizations will also have a significant role in promoting engagement and peer support strategies. The NITT-HT seeks to address behavioral health disparities among racial and ethnic minorities by encouraging the implementation of strategies to decrease the differences in access, service use, and outcomes among these subpopulations of youth in this program.  HYPERLINK \l "_Appendix_J__1" (See Appendix I: Addressing Behavioral Health Disparities). To accomplish program goals, NITT-HT will promote: Creation, implementation and expansion of services and supports that are culturally competent and youth-guided, involve and include family and community members (including business leaders and faith-based organizations), and provide for continuity of care between child- and adult-serving systems to ensure seamless transition. Infrastructure and organization changeat a state/tribal/territorial level to improve cross-system collaboration, service capacity and expertise related to youth and young adults with or at-risk of, serious mental health and substance use disorders as they transition into adult roles and responsibilities. Public awareness, cross-system provider training, e.g. higher education/community colleges, behavioral health, law enforcement, primary care, vocational services and child welfare. NITT-HT is one of SAMHSAs services grant programs. SAMHSA intends that its services grants result in the delivery of services as soon as possible after award. Service delivery should begin by the 6th month of the project at the latest. NITT-HT grants are authorized under Section 520A of the Public Health Service Act, as amended. This announcement addresses Healthy People 2020 Mental Health and Mental Disorders Topic Area HP 2020-MHMD and/or Substance Abuse topic Area HP 2020-SA. 2. EXPECTATIONS SAMHSA expects grantees to focus efforts on two levels: State/tribal/territorial Level Grantees will be expected to increase public awareness, develop outreach and engagement activities, create sustainable services and infrastructure, develop and implement a short and long term strategic policy plan specific to this age group, and enhance cross-system collaboration related to the mental health needs of youth and young adults at the state/tribal/territorial level. These broad issues will include service capacity and effectiveness, access to care, resources and financing, and sustainability, and will ensure the active and meaningful involvement and participation of youth and family members. Grantees may use up to 30 percent of the grant funds at the state/tribal/territorial level for infrastructure activities. Applicants will be expected to coordinate with the State Mental Health Authority on the new five percent Mental Health Block Grant set-a-side funds for the treatment of early serious mental illness will be aligned with the Healthy Transitions efforts. In the application applicants must identify at least two communities to serve as local laboratories to implement the comprehensive awareness, engagement, infrastructure, policy and service delivery approaches. Based on the budget, the applicant must describe and justify the feasibility of implementing the proposed approach, including the achievability of goals at the state/tribal/territorial level and in the identified locatlities. Lessons learned from this local program/practice pilot will then be used to further state/tribal/territorial efforts to expand and sustain services and supports. Required activities include: Development of a Memorandum of Understanding (MOU) between the child mental health system and the adult mental health system at the State/Tribal/Territorial level that contains a plan which: reflects the interests and desired outcomes of both child and adult systems; establishes transition teams that have representation from both child and adult systems that meets every 6 months to review progress on MOU plan; and outlines specific examples of how entities will partner (including responsibilities, assurances and contributions of each entity) throughout the life of the grant to ensure accessibility, continuity of care and a seamless process of transition to adulthood for the population of focus, as well as a plan for sustainability after Federal funds expire. Please include this MOU in Attachment 6. If an MOU does not exist, applicants will be required to complete and submit within the first 60 days of the grant award. Developing a social marketing/communication plan within 6 months of the grant award. Hiring a full time Project Director to manage the project at the state level. The Director should have experience coordinating projects across local service systems and expertise in the field of youth and young adults with serious mental health conditions. Hiring a full time equivalent Youth Coordinator with lived experience at the state level reporting to the Project Director to support development, implementation and evaluation grant activities and ensure that services and systems effectively engage youth. Developing a finance plan that promotes the provision of a seamless cross-agency service delivery system and sustainability of the project at the end of year one of the grant. Creating a state/tribal level transition team with key decision makers or identifying an existing committee with key decision makers who will be responsible for addressing challenges and providing solutions to implementation of this project. Identifying a strategy to coordinate how the new five percent Mental Health Block Grant set-a-side funds for the treatment of early serious mental illness will be aligned with the Healthy Transitions efforts. Development of interagency coordination mechanisms, including the development of a state/tribal/territorial Transition Team that works across systems to improve outreach, engagement and service delivery activities. Engaging in data collection, evaluation, performance measurement and quality improvement efforts Allowable activities include: Developing partnerships with other service and support service providers to enhance continuity of service delivery between child and adult serving systems. Adopting and/or enhancing your computer system, management information system (MIS), electronic health records (EHRs), etc., to document and manage client needs, care process, integration with related support services, and outcomes, across child- and adult- serving systems to provide a more seamless approach to services and supports. Training/workforce development to help your staff or other providers in the community identify mental health or substance abuse issues or provide effective services consistent with the purpose of the grant program. Collaborating with existing federal grant programs and/or interagency teams serving the same population of focus such as state childrens cabinet youth council, shared youth vision team, state and local consumer and family organizations. Ensuring the development, implementation and evaluation of cultural and linguistic competence at the system, organizational and direct service levels of care. Reviewing policies and regulations to improve transition services. Mechanisms to promote and sustain youth and family participation, e.g., peer support, development of youth leadership, mentoring programs, and the partnership between adult consumer organizations and youth-guided activities, youth peer specialists, parent support providers establishing permanent youth and family advisory bodies and self-help organizations/programs. Providing education, outreach, awareness building, and/or social marketing. Activities at the state/tribal and local level to build capacity for appropriate and sustained service delivery to youth and young adults. Conducting an environmental scan. Engaging in strategic planning between child- and adult-serving systems to create a more seamless approach to services and supports. Financing/coordination of funding streams (particularly the incorporation of the SAMHSA-CMS Informational Bulletin titled Coverage of Behavioral Health Services for Children, Youth and Young Adults with Significant Mental Health Conditions) Organizational/structural change (e.g., to create locus of responsibility for a specific issue/population, address behavioral health disparities or to increase access to, or efficiency of, services) Conducting provider training and network development. Creating policies to support needed service system improvements (e.g., establishment of standards of care, adherence to the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care). Local Level Applicants must identify at least two local communities to implement services, and at least 70 percent of the grant funds must be devoted to services. In addition, the identified local communities are required to: Identify and implement specialized evidence-based or evidence-informed services and supports to improve the lives of youth and young adults who have or are at-risk of having a serious mental health and substance use condition(s). Ensure that all service delivery activities must be culturally and linguistically competent, ensure the active participation of youth in service and treatment decisions, involve and include family and community members (including schools, criminal justice, business leaders and faith-based organizations), and provide for continuity of care between child- and adult-serving systems to ensure seamless transitions when necessary. Provide outreach and other engagement strategies to increase participation in, and access for, youth and young adults, ages 16-25 with or at risk of serious emotional conditions. It is anticipated that youth and family organizations should have a significant role in promoting engagement and peer support strategies. Provide outreach and other strategies to increase access, and how evidence-based or evidence-informed treatment services will be incorporated. In addition, describe how you will connect individuals with needed services and how there will be a seamless approach across child and adult systems and across service delivery organizations and agencies. Develop practice guidelines for services and supports for youth/young adults of transition age including common intake, service plans, and shared database, as appropriate and with appropriate privacy protections. Provide screening, assessment, and service coordination, direct treatment and address critical needs in all domains, , i.e., social connectedness, trauma, peer supports. Provide wrap-around/recovery support services which are designed to improve access to and retention in both adult and youth treatment service systems. Examples of such recovery support services include assistance with identifying stable housing, transportation assistance and vocational/educational assistance. Create outreach efforts to identify youth and young adults who either have untreated mental health conditions or are at risk of developing such conditions, with a goal of keeping young people from falling through the cracks, especially after they leave high school. This will be expected to occur at the state/tribal/territorial level and at the local level. These outreach efforts will involve raising awareness through social media and other existing natural networks, (e.g. YMCAs, health fairs, primary care centers, faith organizations and teen centers) that can effectively target youth, family, and community members about the early warning signs of mental illness and action steps to identify needed resources, expanding capacity and improving access to care. It is anticipated that youth and family organizations will also have a significant role in promoting engagement and peer support strategies. For both the state and local levels, grantees must utilize third party and other revenue realized from provision of services to the extent possible and use SAMHSA grant funds only for services to individuals who are ineligible for public or commercial health insurance programs, individuals for whom coverage has been formally determined to be unaffordable, or for services that are not sufficiently covered by an individuals health insurance plan. Grantees are also expected to facilitate the health insurance application and enrollment process for eligible uninsured clients. Grantees should also consider other systems from which a potential service recipient may be eligible for services (for example the Department of Justice, ) if appropriate for and desired by that individual to meet his/her needs. In addition, grantees are required to implement policies and procedures that ensure other sources of funding are secured first when available for that individual. SAMHSAs Recovery Support Strategic Initiative is leading efforts to advance the understanding of recovery and ensure that vital recovery supports and services are available and accessible to all who need and want them. Building on research, practice, and the lived experiences of individuals in recovery from mental and/or substance use disorders, SAMHSA has developed the following working definition of recovery: A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. See  HYPERLINK "http://store.samhsa.gov/product/SAMHSA-s-Working-Definition-of-Recovery/PEP12-RECDEF" http://store.samhsa.gov/product/SAMHSA-s-Working-Definition-of-Recovery/PEP12-RECDEF for further information, including the four dimensions of recovery, and 10 guiding principles. Programs and services that incorporate a recovery approach fully involve people with lived experience (including consumers/peers/people in recovery, youth, and family members) in program/service design, development, implementation, and evaluation. SAMHSAs standard, unified working definition is intended to advance recovery opportunities for all Americans, particularly in the context of health reform, and to help clarify these concepts for peers/persons in recovery, families, funders, providers and others. The definition is to be used to assist in the planning, delivery, financing, and evaluation of behavioral health services. SAMHSA grantees are expected to integrate the definition and principles of recovery into their programs to the greatest extent possible. Accordingly, all SAMHSA grantees that provide services to individuals are encouraged to demonstrate ongoing clinical use of a certified electronic health record (EHR) system in each year of their SAMHSA grant. A certified EHR is an electronic health record system that has been tested and certified by an approved Office of National Coordinators (ONC) certifying body. In  HYPERLINK \l "_Section_F:_Electronic" Section F: Electronic Health Record Technology (EHR), of the Project Narrative, applicants are asked either to: Identify the certified, EHR system that you, or the primary provider of clinical services associated with the grant (i.e., the grantee, sub-awardee or sub-contractor that is expected to deliver clinical services to the most patients during the term of the grant), have adopted to manage client-level clinical information (include a copy of your signed, executed EHR vendor contract in Attachment 5 of your application); or Describe the plan for the primary provider of clinical services to acquire a certified EHR system. This plan should include staffing, training, budget requirements and a timeline for implementation. Alternatively, if you have an EHR system that is not currently certified by an ONC approved certifying body, you may include a letter of commitment from your vendor and associated plan to achieve certification. This should include a timeline. For more information and resources on EHRs, see  HYPERLINK \l "_Appendix_K__1" Appendix J. If your application is funded, you will be expected to develop a health disparities impact statement. This statement consists of three parts: (1) proposed number of individuals to be served by subpopulations (i.e., racial, ethnic, sexual/gender minority groups) vulnerable to health disparities; (2) proposed quality improvement plan to decrease the differences in access, service use and outcomes among those subpopulations; and (3) the quality improvement plan should include alignment with the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care. (See  HYPERLINK \l "_Appendix_J__1" Appendix I: Addressing Behavioral Health Disparities.) 2.1 Using Evidence-Based Practices SAMHSAs services grants are intended to fund services or practices that have a demonstrated evidence base and that are appropriate for the population(s) of focus. An evidence-based practice (EBP) refers to approaches to prevention or treatment that are validated by some form of documented research evidence. In  HYPERLINK \l "_Section_B:_Proposed" Section B of your project narrative, you will need to: Identify the evidence-based or evidence-informed practice(s) you propose to implement for the specific population(s) of focus. Identify and discuss the evidence that shows that the practice(s) is (are) effective for the specific population(s) of focus. If you are proposing to use more than one evidence-based practice, provide a justification for doing so and clearly identify which service modality and population of focus each practice will support. Discuss the population(s) for which the practice(s) has (have) been shown to be effective and show that it (they) is (are) appropriate for your population(s) of focus. If you are choosing a particular model for service delivery, document the evidence that the model you have chosen is appropriate for the outcomes you want to achieve. Explain how the model you have chosen is consistent with the purpose and goals of this grant Initiative. [Note: Please see  HYPERLINK \l "_Appendix_F__1" Appendix E, Funding Restrictions, regarding allowable costs for EBPs.] SAMHSA recognizes that EBPs have not been developed for all populations and/or service settings. See  HYPERLINK \l "_Appendix_C__1" Appendix C for additional information about using EBPs. 2.2 Data Collection and Performance Measurement All SAMHSA grantees are required to collect and report certain data so that SAMHSA can meet its obligations under the Government Performance and Results (GPRA) Modernization Act of 2010. You must document your ability to collect and report the required data in  HYPERLINK \l "_Section_E:_Data" Section D: Data Collection and Performance Measurement of your application. Grantees will be required to report performance on the following infrastructure performance measures: PD1. The number of policy (e.g., infrastructure and organizational) changes completed as a result of the grant. PC1. The number of organizations that entered into formal written inter/intra-organizational agreements (e.g., MOUs/MOAs) to improve mental health-related practices/activities that are consistent with the goals of the grant AW1. The number of individuals exposed to mental health awareness messages. S1. The number of individuals screened for mental health or related interventions. O1. The number of individuals contacted through program outreach efforts. R1. The number of individuals referred to mental health or related services. AC1. The number and percentage of individuals receiving mental health or related services after referral. The grantee will also be expected to collect client level data as part of the TRAC data to include: Assessment of functioning in school, home and in daily life Relationships with family members Ability to adapt and cope particularly when faced with obstacles Assessment of emotional and behavioral, e.g., mood, anxiety, anger, restlessness Assessment of substance use Assessment of vocation and education status Stability in housing Criminal or juvenile justice status Perception of Care It is anticipated that data will be collected at approximately the following intervals: baseline, every 6 months while in the program, discharge, and 6 months post baseline. The collection of these data will enable CMHS to report on the National Outcome Measures (NOMs), which have been defined by SAMHSA as key priority areas relating to mental health. In addition to the NOMs, data collected by grantees will be used to demonstrate how SAMHSAs grant programs are reducing disparities in access, service use, and outcomes nationwide. If you have an electronic health records (EHR) system to collect and manage most or all client-level clinical information, you should use the EHR to automate GPRA reporting. Performance data will be reported to the public, the Office of Management and Budget (OMB) and Congress as part of SAMHSAs budget request. It is anticipated that SAMHSA will award a contract for the design, implementation, and dissemination of findings of a national multi-site evaluation of the Healthy Transitions initiative. Grantees will be expected to fully participate in data collection and other activities that may be required related to the national evaluation. Evaluation and data-related training and technical assistance will be provided to build grantees capacity around data collection, identification of common measures, and the national evaluation design and methodology. The national evaluation will seek to assess, describe, and analyze the Healthy Transitions initiative in several key areas. Potential areas of focus for the national evaluation include the following: identifying effective outreach and engagement strategies for youth and young adults ages 16-25 at risk for behavioral health disorders; describing services and supports for youth and young adults ages 16-25 with serious mental health conditions (and other behavioral health disorders), that are developed, improved, and expanded, as a result of HT; outcomes associated with HT in the areas of education, employment, housing, primary care and mental health (and other behavioral health disorders) for youth and young adults ages 16-25; the effects of HT on involvement with juvenile and criminal justice systems for youth and young adults ages 16-25; factors associated with enhanced and improved collaboration and coordination across youth-serving systems for youth and young adults ages 16-25 at risk for behavioral health disorders; the effects on service capacity and access to care in communities/localities implementing HT; the barriers/facilitators to state/local- level collaboration, partnership development and shared decision making; and the effects of HT on identification and service provision for young people who would have otherwise fallen through the cracks to include those who may have experienced a first episode of psychosis. Data are to be entered into the TRAC reporting system Applicants should be aware that the TRAC reporting system will migrate to the Common Data Platform (CDP) during the life of the grant. 2.3 Local Performance Assessment Grantees must periodically review the performance data they report to SAMHSA (as required above) and assess their progress and use this information to improve management of their grant projects. The assessment should be designed to help you determine whether you are achieving the goals, objectives and outcomes you intend to achieve and whether adjustments need to be made to your project. Performance assessments also should be used to determine whether your project is having/will have the intended impact on behavioral health disparities. You will be required to report on your progress achieved, barriers encountered, and efforts to overcome these barriers in a performance assessment report to be submitted at least annually. At a minimum, your performance assessment should include the required performance measures identified above. You may also consider outcome and process questions, such as the following: Outcome Questions: What was the effect of the intervention on key outcome goals? What program/contextual factors were associated with outcomes? Was the program able to identify young people who would have otherwise fallen through the cracks to include those who may have experienced a first episode of psychosis? Has the program contributed to improvements in the areas of education, vocational, employment, housing, primary care and mental health? Were there positive effects on service capacity and access to care in communities/localities? Has the program enhanced and improved collaboration, coordination, and policies across youth-serving systems? As appropriate, describe how the data, including outcome data, will be analyzed by racial/ethnic group or other demographic factors to assure that appropriate populations are being served and that disparities in services and outcomes are minimized. Process Questions: How closely did implementation match the plan? What types of changes were made to the originally proposed plan? What types of changes were made to address disparities in access, service use, and outcomes across subpopulations, including the use of the National CLAS Standards? What led to the changes in the original plan? What effect did the changes have on the planned intervention and performance assessment? Who provided (program staff) what services (modality, type, intensity, duration), to whom (individual characteristics), in what context (system, community), and at what cost (facilities, personnel, dollars)? What strategies were used to maintain fidelity to the evidence-based practice or intervention across providers over time? How many individuals were reached through the program? The performance assessment should be completed at a minimum of annual, but may be completed as an ad hoc request by the government project officer should there be a cause for concern. At least 10 percent but no more than 15 percent of the total grant award may be used for data collection, performance measurement, and evaluation, e.g., activities required in Sections I-2.2 and 2.3 above. 2.4 Grantee Meetings Grantees must plan to send a representative team (to be determined in conjunction with the GPO) to at least one grantee meeting in each year of the grant. You must include a detailed budget and narrative for this travel in your budget. At these meetings, grantees will present the results of their projects and federal staff will provide technical assistance. These meetings are usually held in the Washington, D.C., area and attendance is mandatory. 1) One 3-day strategic planning meeting in month 6 of year 1. 2) One additional 3-day grantee meeting for each of the remaining grant years. II. AWARD INFORMATION Proposed budgets cannot exceed $1,000,000 in total costs (direct and indirect) in any year of the proposed project. Annual continuation awards will depend on the availability of funds, grantee progress in meeting project goals and objectives, timely submission of required data and reports, and compliance with all terms and conditions of award. These awards will be made as cooperative agreements. Cooperative Agreement These awards are being made as cooperative agreements because they require substantial post-award federal programmatic participation in the conduct of the project. Under this cooperative agreement, the roles and responsibilities of grantees and SAMHSA staff are: Role of Grantee: Comply with the terms and conditions of the agreement which will be specified in the Notice of Award (NoA); Agree to provide SAMHSA with data required for the Government Performance and Results Act (GPRA); Agree to participate in a cross-site evaluation, including collecting and providing data to SAMHSA or its designated contractor using standard protocols to be developed by the contractor; and Develop, with guidance from the Technical Assistance Provider and the Government Project Officer (GPO), an overall strategic plan with implementation benchmarks. Role of SAMHSA Staff: Monitor each grantees progress in the implementation of program requirements and provide direct assistance to advance the goals of the program and to improve the effectiveness of service delivery; Review and approve each stage of project implementation (e.g., continuation applications, proposed programmatic and budgetary modifications and key personnel staffing changes); Participate in making decisions with the grantee to help achieve project objectives; Approve decisions of each grantee regarding: Hiring of key personnel Use of technical assistance resources; and Development and implementation of strategic plan Provide grantees with training and technical assistance to facilitate the planning, development, operation and sustainability of the initiative. III. ELIGIBILITY INFORMATION 1. ELIGIBLE APPLICANTS Eligible applicants are: State governments, Indian or tribal organizations (as defined in Section 4[b] and Section 4[c] of the Indian Self-Determination Act); District of Columbia government and the Commonwealth of Puerto Rico, Northern Mariana Islands, Virgin Islands, Guam, American Samoa and Trust Territory of the Pacific Islands (now Palau, Micronesia and the Marshall Islands). Tribal organization means the recognized body of any AI/AN tribe; any legally established organization of American Indians/Alaska Natives which is controlled, sanctioned, or chartered by such governing body or which is democratically elected by the adult members of the Indian community to be served by such organization and which includes the maximum participation of American Indians/Alaska Natives in all phases of its activities. Consortia of tribes or tribal organizations are eligible to apply, but each participating entity must indicate its approval. Eligibility is limited to states/tribes/territories because the goal is to have services and supports linked and integrated at the state/tribal/territory level in order to effect broad policy change and replication. 2. COST SHARING and MATCH REQUIREMENTS Cost sharing/match is not required in this program. 3. OTHER 3.1 Additional Eligibility Requirements You must comply with the following three requirements, or your application will be screened out and will not be reviewed: use of the SF-424 application form; Budget Information form SF-424A; Project/Performance Site Location(s) form; Disclosure of Lobbying Activities, if applicable; and Checklist. application submission requirements in Section IV-2 of this document; and formatting requirements provided in  HYPERLINK \l "_Appendix_A__1" Appendix A of this document. 3.2 Evidence of Experience and Credentials SAMHSA believes that only existing, experienced, and appropriately credentialed organizations with demonstrated infrastructure and expertise will be able to provide required services quickly and effectively. You must meet three additional requirements related to the provision of services. The three requirements are: A provider organization for direct client substance abuse treatment, substance abuse prevention, and mental health services appropriate to the grant must be involved in the proposed project. The provider may be the applicant or another organization committed to the project. More than one provider organization may be involved; Each mental health/substance abuse treatment provider organization must have at least 2 years experience (as of the due date of the application) providing relevant services in the geographic area(s) in which services are to be provided (official documents must establish that the organization has provided relevant services for the last 2 years; and Each mental health/substance abuse treatment provider organization must comply with all applicable local (city, county) and state licensing, accreditation, and certification requirements, as of the due date of the application. [Note: The above requirements apply to all service provider organizations. A license from an individual clinician will not be accepted in lieu of a provider organizations license. Eligible tribes and tribal organization mental health/substance abuse treatment providers must comply with all applicable tribal licensing, accreditation, and certification requirements, as of the due date of the application. See  HYPERLINK \l "_Appendix_D__" Appendix D, Statement of Assurance.] Following application review, if your applications score is within the funding range, the government project officer (GPO) may contact you to request that the following documentation be sent by overnight mail, or to verify that the documentation you submitted is complete: a letter of commitment from every mental health/substance abuse treatment provider organization that has agreed to participate in the project that specifies the nature of the participation and the service(s) that will be provided; official documentation that all mental health/substance abuse treatment provider organizations participating in the project have been providing relevant services for a minimum of 2 years prior to the date of the application in the area(s) in which the services are to be provided; official documentation that all participating mental health/substance abuse treatment provider organizations: 1) comply with all applicable local (city, county) and state requirements for licensing, accreditation, and certification; OR 2) official documentation from the appropriate agency of the applicable state, county, or other governmental unit that licensing, accreditation, and certification requirements do not exist; and for tribes and tribal organizations only, official documentation that all participating mental health/substance abuse treatment provider organizations: 1) comply with all applicable tribal requirements for licensing, accreditation, and certification; OR 2) documentation from the tribe or other tribal governmental unit that licensing, accreditation, and certification requirements do not exist. If the GPO does not receive this documentation within the time specified, your application will not be considered for an award. IV. APPLICATION AND SUBMISSION INFORMATION CONTENT AND GRANT APPLICATION SUBMISSION You must go to both Grants.gov ( HYPERLINK "http://www.Grants.gov" http://www.Grants.gov) and the SAMHSA website ( HYPERLINK "http://beta.samhsa.gov/grants/applying" http://beta.samhsa.gov/grants/applying) to download the required documents you will need to apply for a SAMHSA grant. Grants.gov How to Download Forms from Grants.gov (see  HYPERLINK \l "_Appendix_B__" Appendix B for information on applying through Grants.gov) To view and/or download the required application forms, you must first search for the appropriate funding announcement number (called the opportunity number). On the Grants.gov site ( HYPERLINK "http://www.Grants.gov" http://www.Grants.gov), select the Apply for Grants option from the Applicants Tab at the top of the screen. Under STEP 1, click on the red button labeled: Download a Grant Application Package. Enter either the Funding Opportunity Number (SAMHSAs Funding Announcement #) or the Catalogue of Federal Domestic Assistance (CFDA) Number exactly as they appear on the cover page of this RFA, then click the Download Package button. In the Instructions column, click the Download link. You can view, print or save all of these forms. You can complete the forms for electronic submission to Grants.gov. Completed forms can also be saved and printed for your records. These required forms include: Application for Federal Assistance (SF-424); Budget Information Non-Construction Programs (SF-424A); Project/Performance Site Location(s) Form; Disclosure of Lobbying Activities; and Checklist. Applications that do not include these required forms will be screened out and will not be reviewed. SAMHSAs Grants Website You will find additional materials you will need to complete your application on SAMHSAs website ( HYPERLINK "http://www.samhsa.gov/grants/apply.aspx" http://beta.samhsa.gov/grants/applying). These include: Request for Applications (RFA) Provides a description of the program, specific information about the availability of funds, and instructions for completing the grant application. This document is the RFA; Assurances Non-Construction Programs; Certifications; and Charitable Choice Form SMA 170. See  HYPERLINK \l "_1.1_Required_Application" Section IV-1.1-Assurances of this RFA to determine if you are required to submit Charitable Choice Form SMA 170. If you are, you can upload this form to Grants.gov when you submit your application. Be sure to check the SAMHSA website periodically for any updates on this program. 1.1 Required Application Components Applications must include the following 12 required application components: Application for Federal Assistance (SF-424) This form must be completed by applicants for all SAMHSA grants. [Note: Applicants must provide a Dun and Bradstreet (DUNS) number to apply for a grant or cooperative agreement from the federal government. SAMHSA applicants are required to provide their DUNS number on the first page of the application. Obtaining a DUNS number is easy and there is no charge. To obtain a DUNS number, access the Dun and Bradstreet website at  HYPERLINK "http://www.dnb.com" http://www.dnb.com or call 1-866-705-5711. To expedite the process, let Dun and Bradstreet know that you are a public/private nonprofit organization getting ready to submit a federal grant application. In addition, you must be registered in the new System for Award Management (SAM). The former Central Contractor Registration (CCR) transitioned to the SAM on July 30, 2012. SAM information must be updated at least every 12 months to remain active (for both grantees and sub-recipients). Once you update your record in SAM, it will take 48 to 72 hours to complete the validation processes. Grants.gov will reject submissions from applicants who are not registered in SAM or those with expired SAM registrations (Entity Registrations). The DUNS number you use on your application must be registered and active in the SAM. To create a user account, Register/Update entity and/or Search Records from CCR, go to  HYPERLINK "https://www.sam.gov" https://www.sam.gov.] Abstract Your total abstract must not be longer than 35 lines. It should include the project name, population(s) to be served (demographics and clinical characteristics), strategies/interventions, project goals and measurable objectives, including the number of people to be served annually and throughout the lifetime of the project, etc. In the first five lines or less of your abstract, write a summary of your project that can be used, if your project is funded, in publications, reports to Congress, or press releases. Table of Contents Include page numbers for each of the major sections ofyour application and for each attachment. Budget Information Form Use SF-424A. Fill out Sections B, C, and E of the SF-424A. A sample budget and justification is included in  HYPERLINK \l "_Appendix_F__" AppendixG of this document. Project Narrative and Supporting Documentation The Project Narrative describes your project. It consists of Sections A through E. Sections A-E together may not be longer than 30 pages. (Remember that if your Project Narrative starts on page 5 and ends on page 35, it is 31 pages long, not 30 pages.) More detailed instructions for completing each section of the Project Narrative are provided in  HYPERLINK \l "_6._OTHER_SUBMISSION" Section V Application Review Information of this document. The Supporting Documentation provides additional information necessary for the review of your application. This supporting documentation should be provided immediately following your Project Narrative in Sections G through I. There are no page limits for these sections, except for Section H, Biographical Sketches/Job Descriptions. Additional instructions for completing these sections are included in  HYPERLINK \l "_SUPPORTING_DOCUMENTATION" Section V under Supporting Documentation. Supporting documentation should be submitted in black and white (no color). Attachments 1 through 6 Use only the attachments listed below. If your application includes any attachments not required in this document, they will be disregarded. Do not use more than a total of 30 pages for Attachments 1, 3 and 4 combined. There are no page limitations for Attachments 2 and 5. Do not use attachments to extend or replace any of the sections of the Project Narrative. Reviewers will not consider them if you do. Please label the attachments as: Attachment 1, Attachment 2, etc. Attachment 1: (1) Identification of at least one experienced, licensed mental health/substance abuse treatment provider organization in each local laboratory; (2) a list of all direct service provider organizations that have agreed to participate in the proposed project, including the applicant agency, if it is a treatment or prevention service provider organization; (3) letters of commitment from these direct service provider organizations; (4) the Statement of Assurance (provided in  HYPERLINK \l "_Appendix_D__" Appendix D of this announcement) signed by the authorized representative of the applicant organization identified on the first page (SF-424) of the application, that assures SAMHSA that all listed providers meet the 2-year experience requirement, are appropriately licensed, accredited, and certified, and that if the application is within the funding range for an award, the applicant will send the GPO the required documentation within the specified time. Attachment 2: Data Collection Instruments/Interview Protocols if you are using standardized data collection instruments/interview protocols, you do not need to include these in your application. Instead, provide a web link to the appropriate instrument/protocol. If the data collection instrument(s) or interview protocol(s) is/are not standardized, you must include a copy in Attachment 2. Attachment 3: Sample Consent Forms Attachment 4: A copy of the state or county strategic plan, a state or county needs assessment, or a letter from the state or county indicating that the proposed project addresses a state- or county-identified priority. Tribal applicants must provide similar documentation relating to tribal priorities. Attachment 5: A copy of the signed, executed EHR vendor contract, if you have an existing EHR system. Attachment 6: MOU between the child mental health system and the adult mental health system. Project/Performance Site Location(s) Form The purpose of this form is to collect location information on the site(s) where work funded under this grant announcement will be performed. This form will be posted on SAMHSAs website with the RFA. Assurances Non-Construction Programs. You must read the list of assurances provided on the SAMHSA website and check the box marked I Agree before signing the first page (SF-424) of the application. You are also required to complete the Assurance of Compliance with SAMHSA Charitable Choice Statutes and Regulations Form SMA 170. This form will be posted on SAMHSAs website at  HYPERLINK "http://beta.samhsa.gov/grants/applying/forms-resources" http://beta.samhsa.gov/grants/applying/forms-resources. Certifications You must read the list of certifications provided on the SAMHSA website and check the box marked I Agree before signing the first page (SF-424) of the application. Disclosure of Lobbying Activities Federal law prohibits the use of appropriated funds for publicity or propaganda purposes or for the preparation, distribution, or use of the information designed to support or defeat legislation pending before Congress or state legislatures. This includes grass roots lobbying, which consists of appeals to members of the public suggesting that they contact their elected representatives to indicate their support for or opposition to pending legislation or to urge those representatives to vote in a particular way. You must sign and submit this form, if applicable. Checklist The Checklist ensures that you have obtained the proper signatures, assurances and certifications. You must complete the entire form, including the top portion, Type of Application, indicating if this is a new, noncompeting continuation, competing continuation or supplemental application, as well as Parts A through D. Documentation of nonprofit status as required in the Checklist. 1.2 Application Formatting Requirements Please refer to  HYPERLINK \l "_Appendix_A__" Appendix A, Checklist for Formatting Requirements and Screen- out Criteria for SAMHSA Grant Applications, for SAMHSAs basic application formatting requirements. Applications that do not comply with these requirements will be screened out and will not be reviewed. 2. APPLICATION SUBMISSION REQUIREMENTS Applications are due by 11:59 PM (Eastern Time) on June 13, 2014. Your application must be submitted through  HYPERLINK "http://www.Grants.gov" http://www.Grants.gov. Please refer to  HYPERLINK \l "_Appendix_B__" Appendix B, Guidance for Electronic Submission of Applications. 4. FUNDING LIMITATIONS/RESTRICTIONS Cost principles describing allowable and unallowable expenditures for federal grantees, including SAMHSA grantees, are provided in the following documents, which are available at  HYPERLINK "http://www.samhsa.gov/grants/management.aspx" http://www.samhsa.gov/grants/management.aspx: Educational Institutions: 2 CFR Part 220 and OMB Circular A-21 State, Local and Indian Tribal Governments: 2 CFR Part 225 (OMB Circular A-87) Nonprofit Organizations: 2 CFR Part 230 (OMB Circular A-122) Hospitals: 45 CFR Part 74, Appendix E In addition, SAMHSAs NITT-HT grant recipients must comply with the following funding restrictions: No more than 30 percent of the total grant award will be used for infrastructure development, including data collection, performance measurement and performance assessment; and No less than 70 percent of the total grant award is used for services. Be sure to identify these expenses in your proposed budget. Where applicable, SAMHSA grantees also must comply with SAMHSAs standard funding restrictions, which are included in  HYPERLINK \l "_Appendix_F__1" Appendix E. V. APPLICATION REVIEW INFORMATION 1. EVALUATION CRITERIA The Project Narrative describes what you intend to do with your project and includes the Evaluation Criteria in Sections A-F below. Your application will be reviewed and scored according to the quality of your response to the requirements in Sections A-F. In developing the Project Narrative section of your application, use these instructions, which have been tailored to this program. The Project Narrative (Sections A-F) together may be no longer than 30 pages. You must use the seven sections/headings listed below in developing your Project Narrative. You must place the required information in the correct section, or it will not be considered. Your application will be scored according to how well you address the requirements for each section of the Project Narrative. The Budget Justification and Supporting Documentation you provide in Sections G-J and Attachments 1-6 will be considered by reviewers in assessing your response, along with the material in the Project Narrative. The number of points after each heading is the maximum number of points a review committee may assign to that section of your Project Narrative. Although scoring weights are not assigned to individual bullets, each bullet is assessed in deriving the overall Section score. Section A: Population of Focus and Statement of Need (15 points) Provide a comprehensive demographic profile of your population of focus in terms of race, ethnicity, language, gender, age, socioeconomic characteristics, sexual identity (sexual orientation, gender identity) and other relevant factors, such as literacy. Discuss the relationship of your population of focus, including any specialized youth and young adult populations, e.g., those who are homeless, LGBT, to the overall population in your geographic catchment area and identify any disparities, if any, relating to access/use/outcomes of your provided services citing relevant data. Demonstrate an understanding of these populations consistent with the purpose of your program and intent of the RFA. Describe the nature of the problem, including service gaps, and document the extent of the need (i.e., current prevalence rates or incidence data) for the population(s) of focus based on data. Identify the source of the data. Documentation of need may come from a variety of qualitative and quantitative sources. Examples of data sources for the quantitative data that could be used are local epidemiologic data, state data (e.g., from state needs assessments, SAMHSAs National Survey on Drug Use and Health), and/or national data [e.g., from SAMHSAs National Survey on Drug Use and Health or from National Center for Health Statistics/Centers for Disease Control and Prevention (CDC) reports, and Census data]. This list is not exhaustive; applicants may submit other valid data, as appropriate for your program. Describe input you have received from youth, young adults and family members regarding the need for this project and the development of your application. Describe the locality or localities that you plan to use as a local laboratories to implement the comprehensive awareness, engagement, infrastructure and policy and service delivery approaches. Identify the localities needs and readiness to participate in the cooperative agreement, and how the lessons learned will be used to expand and sustain the activities. Given the budget, discuss why you believe it is feasible to implement at these identified localities. Section B: Proposed Infrastructure Approach (30 points) Describe how achievement of the goals will produce meaningful and relevant results (e.g., increase access, availability, prevention of negative behaviors, outreach, treatment, and/or intervention) and support SAMHSAs goals for the program. Describe your plans to identify and engage youth that might otherwise fall through the cracks. Describe how you will develop the state/tribal/territorial and local infrastructure to ensure the successful implementation of your project. This includes how you will address awareness, financing and coordination of funding streams, organizational structure and locus of responsibility, interagency coordination and agreements,organizational development and workforce development and training. Describe the members of the state/tribal/territorial transition team and how the team will function, operate and oversee the cross-system activities to ensure a seamless approach for outreach, engagement and service delivery. Describe your strategies to develop practice guidelines for services and supports for youth/young adults of transition age including common intake, service plans, and shared database as appropriate and with appropriate privacy protections. Describe your approach to raising awareness through social media and other existing natural networks that will effectively target youth, family, and community members about the early warning signs of mental illness and how you will develop action steps to identify needed resources, expanding capacity and improving access to care. Provide a chart or graph depicting a realistic time line for the entire project period showing key activities, milestones, and responsible staff. These key activities should include the requirements outlined in  HYPERLINK \l "_2._EXPECTATIONS" Section 1-2: Expectations. Be sure to show that the project can be implemented and service delivery can begin as soon as possible and no later than 6 months after grant award. [Note: The time line should be part of the Project Narrative. It should not be placed in an attachment.] State the unduplicated number of individuals you propose to serve, including any specialized populations (e.g., sexual or gender minorities, ethnic or racial minorities, homeless youth), with grant funds (annually and over the entire project period), including the types and numbers of services to be provided and anticipated outcomes. You are required to include the numbers to be served by race, ethnicity, gender, and sexual orientation. Section C: Proposed Service Level Approach (30 points) Describe how you will identify, screen and assess young people for the presence of serious mental health disorders (i.e., early onset psychosis, bipolar disorder), co-occurring mental and substance use disorders and the potential for dangerousness, and how you will use the information to develop appropriate engagement and treatment approaches. Describe how you will incorporate cultural competence and responsiveness as part of the proposed approach, including strategies related to youth culture and strategies to engage community partners (e.g., existing natural networks, YMCAs, health fairs, primary care centers, faith organizations and teen centers). Describe how you will engage youth and young adults of transition age, family members and community partners and how they will have a significant role identifying and promoting engagement and peer support strategies. Describe strategies to blend approaches to meet individual needs (wraparound). Note: Grant funds may be used to purchase such services from another provider. Describe how services will be created and modified for different age groups within this age range (16-25). Youth and young adults need services and support from both child and adult mental health systems and need the ability to use any of those services. Show how you will bridge the gap between child and adult mental health systems being flexible to serve youth and young adults based on their needs, i.e., flexibility to choose from a wide variety of services and supports from both child and adult systems. Describe the Evidence-Based Practice (EBP) or evidence-informed practice(s) that will be used and justify its use for your population of focus, your proposed program, and the intent of this RFA. Describe how the proposed practice will address the following issues in the population(s) of focus, while retaining fidelity to the chosen practice: demographics (race, ethnicity, religion, gender, age, geography, and socioeconomic status); language and literacy; sexual identity (sexual orientation, gender identity); and disability. [See  HYPERLINK \l "_Appendix_C__1" Appendix C: Using Evidence-Based Practices (EBPs).] Section D: Staff and Organizational Experience (10 points) Discuss the capability and experience of the applicant organization and other participating organizations with similar projects and populations. Demonstrate that the applicant organization and other participating organizations have linkages to the population(s) of focus and ties to grassroots/community-based organizations that are rooted in the culture(s) and language(s) of the population(s) of focus. Provide a complete list of staff positions for the project, including the Project Director and Youth Coordinator and showing the role of each and their level of effort and qualifications. Demonstrate the expertise of identified staff and provide a rationale for the staffing structure. Discuss how key staff have demonstrated experience and are qualified to serve the population(s) of focus and are familiar with their culture(s) and language(s). Section E: Data Collection and Performance Measurement (10 points) Document your ability to collect and report on the required performance measures as specified in  HYPERLINK \l "_2.4_Data_Collection" Section I-2.2 of this RFA. Describe your plan for data collection, management, analysis and reporting. Specify and justify any additional measures or instruments you plan to use for your grant project. Describe the data-driven quality improvement process by which sub-population disparities in access/use/outcomes will be tracked, assessed, and reduced. Describe your plan for conducting the local performance assessment as specified in  HYPERLINK \l "_2.3_Local_Performance" Section I-2.3 of this RFA and document your ability to conduct the assessment. Section F: Electronic Health Record (EHR) Technology (5 points) If you currently have an existing EHR system, identify the EHR system that you, or the primary provider of clinical services associated with the grant (i.e., the grantee, sub-awardee or sub-contractor that is expected to deliver clinical services to the most patients during the term of the grant), have adopted to manage client-level clinical information for your proposed project. Include a copy of your EHR vendor contract in Attachment 5 of your application. If you or the primary provider of clinical services do not currently have an existing EHR system, describe the plan to acquire an EHR system. This plan should include staffing, training, budget requirements (including additional resources for funding), and a time line for implementation. Be sure to include these costs in your budget. Alternatively, if you have an EHR system that is not currently certified by an ONC approved certifying body, you may include a letter of commitment from your vendor and associated plan to achieve certification. This should include a time line. NOTE: Although the budget for the proposed project is not a scored review criterion, the Review Group will be asked to comment on the appropriateness of the budget to the scope of the proposal after the merits of the application have been considered. Budget Justification, Existing Resources, Other Support (other federal and non-federal sources) You must provide a narrative justification of the items included in your proposed budget, as well as a description of existing resources and other support you expect to receive for the proposed project. Other support is defined as funds or resources, whether federal, non-federal or institutional, in direct support of activities through fellowships, gifts, prizes, in-kind contributions or non-federal means. (This should correspond to Item #18 on your SF-424, Estimated Funding.) Other sources of funds may be used for unallowable costs, e.g., meals, sporting events, entertainment. Please note: No more than 30 percent of the total grant award will be used for infrastructure development, including data collection, performance measurement and performance assessment and that no less than 70 percent of the total grant award be used for services. Specifically identify the items associated with these costs in your budget. An illustration of a budget and narrative justification is included in  HYPERLINK \l "_Appendix_I_" Appendix G, Sample Budget and Justification, of this document. The budget justification and narrative must be submitted as file BNF when you submit your application into Grants.gov. ( HYPERLINK \l "_Appendix_B__" See  HYPERLINK \l "_Appendix_B__" Appendix B, Guidance for Electronic Submission of Applications.) SUPPORTING DOCUMENTATION Section G: Literature Citations. This section must contain complete citations, including titles and all authors, for any literature you cite in your application. Section H: Biographical Sketches and Job Descriptions. Include position descriptions for the Project Director and all key personnel. Position descriptions should be no longer than 1 page each. For staff that have been identified, include a biographical sketch for the Project Director, Youth Coordinator and other key positions. Each sketch should be 2 pages or less. Reviewers will not consider information past page 2. Information on what you should include in your biographical sketches and job descriptions can be found in  HYPERLINK \l "_Appendix_I__1" Appendix F of this document. Section I: Confidentiality and SAMHSA Participant Protection/Human Subjects: You must describe procedures relating to Confidentiality, Participant Protection and the Protection of Human Subjects Regulations in Section I of your application. See  HYPERLINK \l "_Appendix_J_" Appendix H for guidelines on these requirements. 2. REVIEW AND SELECTION PROCESS SAMHSA applications are peer-reviewed according to the evaluation criteria listed above. Decisions to fund a grant are based on: the strengths and weaknesses of the application as identified by peer reviewers; when the individual award is over $150,000, approval by the Center for Mental Health Services National Advisory Council;and availability of funds; and equitable distribution of awards in terms of geography (including urban, rural and remote settings) and balance among populations of focus and program size. VI. ADMINISTRATION INFORMATION 1. AWARD NOTICES You will receive a letter from SAMHSA through postal mail that describes the general results of the review of your application, including the score that your application received. If you are approved for funding, you will receive an additional notice through postal mail, the Notice of Award (NoA), signed by SAMHSAs Grants Management Officer. The Notice of Award is the sole obligating document that allows you to receive federal funding for work on the grant project. If you are not funded, you will receive notification from SAMHSA. 2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS If your application is funded, you must comply with all terms and conditions of the grant award. SAMHSAs standard terms and conditions are available on the SAMHSA website at  HYPERLINK "http://www.samhsa.gov/grants/management.aspx" http://www.samhsa.gov/grants/management.aspx. If your application is funded, you must also comply with the administrative requirements outlined in 45 CFR Part 74 or 45 CFR Part 92, as appropriate. For more information see the SAMHSA website ( HYPERLINK "http://www.samhsa.gov/grants/management.aspx" http://www.samhsa.gov/grants/management.aspx). Depending on the nature of the specific funding opportunity and/or your proposed project as identified during review, SAMHSA may negotiate additional terms and conditions with you prior to grant award. These may include, for example: actions required to be in compliance with confidentiality and participant protection/human subjects requirements; requirements relating to additional data collection and reporting; requirements relating to participation in a cross-site evaluation; requirements to address problems identified in review of the application; or revised budget and narrative justification. If your application is funded, you will be held accountable for the information provided in the application relating to performance targets. SAMHSA program officials will consider your progress in meeting goals and objectives, as well as your failures and strategies for overcoming them, when making an annual recommendation to continue the grant and the amount of any continuation award. Failure to meet stated goals and objectives may result in suspension or termination of the grant award, or in reduction or withholding of continuation awards. If your application is funded, you must comply with Executive Order 13166, which requires that recipients of federal financial assistance provide meaningful access to limited English proficient (LEP) persons in their programs and activities. You may assess the extent to which language assistance services are necessary in your grant program by utilizing the HHS Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons, available at  HYPERLINK "http://www.hhs.gov/ocr/civilrights/resources/laws/revisedlep.html" http://www.hhs.gov/ocr/civilrights/resources/laws/revisedlep.html. Grant funds cannot be used to supplant current funding of existing activities. Supplant is defined as replacing funding of a recipients existing program with funds from a federal grant. 3. REPORTING REQUIREMENTS In addition to the data reporting requirements listed in  HYPERLINK \l "_2.4_Data_Collection" Section I-2.2, grantees must comply with the reporting requirements listed on the SAMHSA website at  HYPERLINK "http://www.samhsa.gov/grants/apply.aspx" http://beta.samhsa.gov/grants/applying/reporting-requirements). VII. AGENCY CONTACTS For questions about program issues contact: Debra Cady Public Health Advisor/Government Project Officer Child, Adolescent and Family Branch Center for Mental Health Services Substance Abuse and Mental Health Services Administration 1 Choke Cherry Road, Suite 6-1048 Rockville, MD 20850 (240) 276-1929  HYPERLINK "mailto:debra.cady@samhsa.hhs.gov" debra.cady@samhsa.hhs.gov Diane Sondheimer Deputy Chief Child, Adolescent, and Family Branch Center for Mental Health Services Substance Abuse and Mental Health Services Administration 1 Choke Cherry Road, Room 6-1043 Rockville, Maryland 20857 (240) 276-1922 HYPERLINK "mailto:diane.sondheimer@samhsa.hhs.gov"diane.sondheimer@samhsa.hhs.gov For questions on grants management and budget issues contact: Gwendolyn Simpson Office of Financial Resources, Division of Grants Management Substance Abuse and Mental Health Services Administration 1 Choke Cherry Road Room 7-1091 Rockville, Maryland 20857 (240) 276-1408  HYPERLINK "mailto:gwendolyn.simpson@samhsa.hhs.gov" gwendolyn.simpson@samhsa.hhs.gov Appendix A Checklist for Formatting Requirements and Screen-out Criteria for SAMHSA Grant Applications SAMHSAs goal is to review all applications submitted for grant funding. However, this goal must be balanced against SAMHSAs obligation to ensure equitable treatment of applications. For this reason, SAMHSA has established certain formatting requirements for its applications. If you do not adhere to these requirements, your application will be screened out and returned to you without review. Use the SF-424 Application form; Budget Information form SF-424A; Project/Performance Site Location(s) form; Disclosure of Lobbying Activities, if applicable; and Checklist. Applications must be received by the application due date and time, as detailed in  HYPERLINK \l "_3._SUBMISSION_DATES" Section IV-2 of this grant announcement. You must be registered in the System Award Management (SAM) prior to submitting your application. The DUNS number used on your application must be registered and active in the SAM prior to submitting your application. Information provided must be sufficient for review. Text must be legible. Pages must be typed in black, single-spaced, using a font of Times New Roman 12, with all margins (left, right, top, bottom) at least one inch each. You may use Times New Roman 10 only for charts or tables. (See additional requirements in  HYPERLINK \l "_Appendix_B__" Appendix B, Guidance for Electronic Submission of Applications.) To ensure equity among applications, page limits for the Project Narrative cannot be exceeded. To facilitate review of your application, follow these additional guidelines. Failure to adhere to the following guidelines will not, in itself, result in your application being screened out and returned without review. However, the information provided in your application must be sufficient for review. Following these guidelines will help ensure your application is complete, and will help reviewers to consider your application. Applications should comply with the following requirements: Provisions relating to confidentiality and participant protection/human subjects specified in  HYPERLINK \l "_Appendix_K_" Appendix H of this announcement Budgetary limitations as specified in  HYPERLINK \l "_I._FUNDING_OPPORTUNITY" Sections I,  HYPERLINK \l "_II._AWARD_INFORMATION" II, and  HYPERLINK \l "_4._FUNDING_LIMITATIONS/RESTRICTIONS" IV-4 of this announcement Documentation of nonprofit status as required in the Checklist. Black print should be used throughout your application, including charts and graphs (no color). Materials with printing on both sides will be excluded from the application and not sent to peer reviewers. Pages should be numbered consecutively from beginning to end so that information can be located easily during review of the application. The abstract page should be page 1, the table of contents should be page 2, etc. The four pages of the SF-424 are not to be numbered. Attachments should be labeled and separated from the Project Narrative and budget section, and the pages should be numbered to continue the sequence. The page limits for Attachments stated in  HYPERLINK \l "_1.1_Required_Application" Section IV-1.1 of this announcement should not be exceeded. Appendix B Guidance for Electronic Submission of Applications SAMHSA discretionary grant applications must be submitted electronically through Grants.gov. SAMHSA will not accept paper applications, except when a waiver of this requirement is approved by SAMHSA. The process for applying for a waiver is described later in this appendix. If this is the first time you have submitted an application through Grants.gov, you must complete three separate registration processes before you can submit your application. Allow at least two weeks (10 business days) for these registration processes, prior to submitting your application. The processes are: DUNS Number registration: The DUNS number you use on your application must be registered and active in the SAM. System for Award Management (SAM) registration: The System for Award Management (SAM) is a federal government owned and operated free website that replaces capabilities of the former Central Contractor Registry (CCR) system, as well as EPLS. Future phases of SAM will add the capabilities of other systems used in federal awards processes. SAM information must be updated at least every 12 months to remain active (for both grantees and sub-recipients). Once you update your record in SAM, it will take 48 to 72 hours to complete the validation processes. Grants.gov will reject electronic submissions from applicants with expired registrations. To create a user account, Register/Update entity and/or Search Records from CCR, go to  HYPERLINK "https://www.sam.gov" https://www.sam.gov. You will find a Quick Start Guide for Entities Interested in Being Eligible for Grants through SAM at  HYPERLINK "https://www.sam.gov/sam/transcript/Quick_Guide_for_Grants_Registrations.pdf" https://www.sam.gov/sam/transcript/Quick_Guide_for_Grants_Registrations.pdf. Grants.gov Registration (get username and password): Be sure the person submitting your application is properly registered with Grants.gov as the Authorized Organization Representative (AOR) for the specific DUNS number cited on the SF-424 (first page). See the Organization Registration User Guide for details at the following Grants.gov link:  HYPERLINK "http://www.grants.gov/web/grants/applicants/organization-registration.html" http://www.grants.gov/web/grants/applicants/organization-registration.html. You can find additional information on the registration process at  HYPERLINK "http://www.grants.gov/web/grants/outreach/grantsgov-training.html" http://www.grants.gov/web/grants/outreach/grantsgov-training.html. To submit your application electronically, you may search  HYPERLINK "http://www.Grants.gov" http://www.Grants.gov for the downloadable application package by the funding announcement number (called the opportunity number) or by the Catalogue of Federal Domestic Assistance (CFDA) number. You can find the funding announcement number and CFDA number on the cover page of this funding announcement. You must follow the instructions in the User Guide available at the  HYPERLINK "http://www.Grants.gov" http://www.Grants.gov apply site, on the Help page. In addition to the User Guide, you may wish to use the following sources for technical (IT) help: By e-mail: support@Grants.gov By phone: 1-800-518-4726 (1-800-518-GRANTS). The Grants.gov Contact Center is available 24 hours a day, 7 days a week, excluding federal holidays. Please allow sufficient time to enter your application into Grants.gov. When you submit your application, you will receive a notice that your application is being processed and that you will receive two e-mails from Grants.gov within the next 24-48 hours. One will confirm receipt of the application in Grants.gov, and the other will indicate that the application was either successfully validated by the system (with a tracking number) or rejected due to errors. It will also provide instructions that if you do not receive a receipt confirmation and a validation confirmation or a rejection e-mail within 48 hours, you must contact Grants.gov directly. It is important that you retain this tracking number. Receipt of the tracking number is the only indication that Grants.gov has successfully received and validated your application. If you do not receive a Grants.gov tracking number, you may want to contact the Grants.gov help desk for assistance. Please note that it is incumbent on the applicant to monitor your application to ensure that it is successfully received and validated by Grants.gov. If your application is not successfully validated by Grants.gov, it will not be forwarded to SAMHSA as the receiving institution. If you experience issues/problems with electronic submission of your application through Grants.gov, contact the Grants.gov helpdesk by email at  HYPERLINK "mailto:support@grants.gov" support@grants.gov or by phone at 1-800-518-4726 (1-800-518-GRANTS). Make sure you get a case/ticket/reference number that documents the issues/problems with Grants.gov. It is critical that you initiate electronic submission in sufficient time to resolve any issues/problems that may prevent the electronic submission of your application. Grants.gov will reject applications submitted after 11:59 PM on the application due date. SAMHSA highly recommends that you submit your application 24-48 hours before the submission deadline. Many submission issues can be fixed within that time and you can attempt to re-submit. However, if you have not completed your Grants.gov, SAM, and DUNS registration at least 2 weeks prior to the submission deadline, it is highly unlikely that these issues will be resolved in time to successfully submit an electronic application. It is strongly recommended that you prepare your Project Narrative and other attached documents in Adobe PDF format. If you do not have access to Adobe software, you may submit in Microsoft Office 2007 products (e.g., Microsoft Word 2007, Microsoft Excel 2007, etc.). Directions for creating PDF files can be found on the Grants.gov website. Use of file formats other than Adobe PDF or Microsoft Office 2007 may result in your file being unreadable by our staff. The Abstract, Table of Contents, Project Narrative, Supporting Documentation, Budget Justification, and Attachments must be combined into 4 separate files in the electronic submission. If the number of files exceeds 4, only the four files will be downloaded and considered in the peer review of applications. Formatting requirements for SAMHSA e-Grant application files are as follows: Project Narrative File (PNF): The PNF consists of the Abstract, Table of Contents, and Project Narrative (Sections A-F) in this order and numbered consecutively. Budget Narrative File (BNF): The BNF consists of only the budget justification narrative. Other Attachment File 1: The first Other Attachment file will consist of the Supporting Documentation (Sections G-I) in this order and lettered consecutively. Other Attachment File 2: The second Other Attachment file will consist of the Attachments (Attachments 1-6) in this order and numbered consecutively. If you have documentation that does not pertain to any of the 4 listed attachment files, include that documentation in Other Attachment File 2. Other Grants.gov Requirements Applicants are limited to using the following characters in all attachment file names: Valid file names may include only the following characters: A-Z a-z 0-9 Underscore _ Hyphen Space Period . If your application uses any other characters when naming your attachment files, your application will be rejected by Grants.gov. Do not use special characters in file names, such as parenthesis ( ), #, , etc. Scanned images must be scanned at 150-200 dpi/ppi resolution and saved as a jpeg or pdf file. Using a higher resolution setting or different file type could result in rejection of your application. Waiver Request Process Applicants may request a waiver of the requirement for electronic submission if they are unable to submit electronically through the Grants.gov portal because their physical location does not have adequate access to the Internet. Inadequate Internet access is defined as persistent and unavoidable access problems/issues that would make compliance with the electronic submission requirement a hardship. The process for applying for a waiver is described below. Questions on applying for a waiver may be directed to SAMHSAs Division of Grant Review, 240-276-1199. All applicants must register in the System for Award Management (SAM) and Grants.gov, even those who intend to request a waiver. If you do not have an active SAM registration prior to submitting your paper application, it will be screened out and returned to you without review. Registration is necessary to ensure that information required for paper submission is available and that the applicant is ready to submit electronically if the waiver is denied. (See directions for registering in SAM and on Grants.gov above.) A written waiver request must be received by SAMHSA at least 15 calendar days in advance of the application due date stated on the cover page of this RFA. The request must be either e-mailed to  HYPERLINK "mailto:DGR.Waivers@samhsa.hhs.gov" DGR.Waivers@samhsa.hhs.gov, or mailed to: Diane Abbate, Director of Grant Review Office of Financial Resources Substance Abuse and Mental Health Services Administration Room 3-1044 1 Choke Cherry Road Rockville, MD 20857 Applicants are encouraged to request a waiver by e-mail, when possible. When requesting a waiver, the following information must be included: SAMHSA RFA title and announcement number; Name, address, and telephone number of the applicant organization as they will appear in the application; Applicant organizations DUNS number; Authorized Organization Representative (AOR) for the named applicant; Name, telephone number, and e-mail of the applicant organizations Contact Person for the waiver; and Details of why the organization is unable to submit electronically through the Grants.gov portal, explaining why their physical location does not have adequate access to the Internet. The Office of Grant Review will either e-mail (if the waiver request was received by e-mail) or express mail/deliver (if the waiver request was received by mail) the waiver decision to the Contact Person no later than seven calendar days prior to the application due date. If the waiver is approved, a paper application must be submitted. (See instructions for submitting a paper application below.) SAMHSA will not accept any applications that are sent by e-mail or facsimile or hand carried. If the waiver is disapproved, the applicant organization must be prepared to submit through Grants.gov or forfeit the opportunity to apply. The written approval must be included as the cover page of the paper application and the application must be received by the due date. A waiver approval is valid for the remainder of the fiscal year and may be used for other SAMHSA discretionary grant applications during that fiscal year. When submitting a subsequent paper application within the same fiscal year, this waiver approval must be included as the cover page of each paper application. The organization and DUNS number named in the waiver and any subsequent application must be identical. A paper application will not be accepted without the waiver approval and will be returned to the applicant if it is not included. Paper applications received after the due date will not be accepted. Instructions for Submitting a Paper Application with a Waiver Paper submissions are due by 5:00 PM on the application due date stated on the cover page of this RFA. Applications may be shipped using only Federal Express (FedEx), United Parcel Service (UPS), or the United States Postal Service (USPS). You will be notified by postal mail that your application has been received. Note: If you use the USPS, you must use Express Mail. SAMHSA will not accept or consider any applications that are sent by e-mail or facsimile or hand carried. If you are submitting a paper application, you must submit an original application and 2 copies (including attachments). The original and copies must not be bound and nothing should be attached, stapled, folded, or pasted. Do not use staples, paper clips, or fasteners. You may use rubber bands. Send applications to the address below: For United States Postal Service: Diane Abbate, Director of Grant Review Office of Financial Resources Substance Abuse and Mental Health Services Administration Room 3-1044 1 Choke Cherry Road Rockville, MD 20857 Change the zip code to 20850 if you are using FedEx or UPS. Do not send applications to other agency contacts, as this could delay receipt. Be sure to include Healthy Transitions and RFA # SM-14-017 in item number 12 on the first page (SF-424) of your paper application. If you require a phone number for delivery, you may use (240) 276-1199. Your application must be received by the application deadline or it will not be considered for review. Please remember that mail sent to federal facilities undergoes a security screening prior to delivery. You are responsible for ensuring that you submit your application so that it will arrive by the application due date and time. If an application is mailed to a location or office (including room number) that is not designated for receipt of the application and, as a result, the designated office does not receive your application by the deadline, your application will be considered late and ineligible for review. If you are submitting a paper application, the application components required for SAMHSA applications should be submitted in the following order: Application for Federal Assistance (SF-424) Abstract Table of Contents Budget Information Form (SF-424A) Project Narrative and Supporting Documentation Attachments Project/Performance Site Location(s) Form Disclosure of Lobbying Activities (Standard Form LLL, if applicable) Checklist the Checklist should be the last page of your application. Documentation of nonprofit status as required in the Checklist Do not use heavy or lightweight paper or any material that cannot be copied using automatic copying machines. Odd-sized and oversized attachments, such as posters, will not be copied or sent to reviewers. Do not include videotapes, audiotapes, or CD-ROMs. Black print should be used throughout your application, including charts and graphs (no color). Pages should be typed single-spaced with one column per page. Pages should not have printing on both sides. Pages with printing on both sides run the risk of an incomplete application going to peer reviewers, since scanning and copying may not duplicate the second side. Materials with printing on both sides will be excluded from the application and not sent to peer reviewers. With the exception of standard forms in the application package, all pages in your application should be numbered consecutively. Documents containing scanned images must also contain page numbers to continue the sequence. Failure to comply with these requirements may affect the successful transmission and consideration of your application. Appendix C Using Evidence-Based Practices (EBPs) SAMHSA recognizes that EBPs have not been developed for all populations and/or service settings. For example, certain interventions for American Indians/Alaska Natives, rural or isolated communities, or recent immigrant communities may not have been formally evaluated and, therefore, have a limited or nonexistent evidence base. In addition, other interventions that have an established evidence base for certain populations or in certain settings may not have been formally evaluated with other subpopulations or within other settings. Applicants proposing to serve a population with an intervention that has not been formally evaluated with that population are required to provide other forms of evidence that the practice(s) they propose is appropriate for the population(s) of focus. Evidence for these practices may include unpublished studies, preliminary evaluation results, clinical (or other professional association) guidelines, findings from focus groups with community members, etc. You may describe your experience either with the population(s) of focus or in managing similar programs. Information in support of your proposed practice needs to be sufficient to demonstrate the appropriateness of your practice to the individuals reviewing your application. Document the evidence that the practice(s) you have chosen is appropriate for the outcomes you want to achieve. Explain how the practice you have chosen meets SAMHSAs goals for this grant program. Describe any modifications/adaptations you will need to make to your proposed practice(s) to meet the goals of your project and why you believe the changes will improve the outcomes. We expect that you will implement your evidence-based service(s)/practice(s) in a way that is as close as possible to the original service(s)/practice(s). However, SAMHSA understands that you may need to make minor changes to the service(s)/practice(s) to meet the needs of your population(s) of focus or your program, or to allow you to use resources more efficiently. You must describe any changes to the proposed service(s)/practice(s) that you believe are necessary for these purposes. You may describe your own experience either with the population(s) of focus or in managing similar programs. However, you will need to convince the people reviewing your application that the changes you propose are justified. Explain why you chose this evidence-based practice over other evidence-based practices. If applicable, justify the use of multiple evidence-based practices. Discuss how the use of multiple evidence-based practices will be integrated into the program, while maintaining an appropriate level of fidelity for each practice. Describe how the effectiveness of each evidence-based practice will be quantified in the performance assessment of the project. Discuss training needs or plans for training to successfully implement the proposed evidence-based practice(s). Resources for Evidence-Based Practices: You will find information on evidence-based practices in SAMHSAs Guide to Evidence-Based Practices on the Web at  HYPERLINK "http://www.samhsa.gov/ebpwebguide" http://www.samhsa.gov/ebpwebguide. SAMHSA has developed this website to provide a simple and direct connection to websites with information about evidence-based interventions to prevent and/or treat mental and substance use disorders. The Guide provides a short description and a link to dozens of websites with relevant evidence-based practices information either specific interventions or comprehensive reviews of research findings. Please note that SAMHSAs Guide to Evidence-Based Practices on the Web also references another SAMHSA website, the National Registry of Evidence-Based Programs and Practices (NREPP). NREPP is a searchable database of interventions for the prevention and treatment of mental and substance use disorders. NREPP is intended to serve as a decision support tool, not as an authoritative list of effective interventions. Being included in NREPP, or in any other resource listed in the Guide, does not mean an intervention is recommended or that it has been demonstrated to achieve positive results in all circumstances. You must document that the selected practice is appropriate for the specific population(s) of focus and purposes of your project. In addition to the website noted above, you may provide information on research studies to show that the services/practices you plan to implement are evidence-based. This information is usually published in research journals, including those that focus on minority populations. If this type of information is not available, you may provide information from other sources, such as unpublished studies or documents describing formal consensus among recognized experts. [Note: Please see  HYPERLINK \l "_Appendix_F__1" Appendix E, Funding Restrictions, regarding allowable costs for EBPs.] Appendix D Statement of Assurance As the authorized representative of [insert name of applicant organization] _________________________________________________, I assure SAMHSA that all participating service provider organizations listed in this application meet the two-year experience requirement and applicable licensing, accreditation, and certification requirements. If this application is within the funding range for a grant award, we will provide the SAMHSA Government Project Officer (GPO) with the following documents. I understand that if this documentation is not received by the GPO within the specified timeframe, the application will be removed from consideration for an award and the funds will be provided to another applicant meeting these requirements. a letter of commitment from every mental health/substance abuse treatment service provider organization listed in Attachment 1 of the application that specifies the nature of the participation and the service(s) that will be provided; official documentation that all mental health/substance abuse treatment provider organizations participating in the project have been providing relevant services for a minimum of 2 years prior to the date of the application in the area(s) in which services are to be provided. Official documents must definitively establish that the organization has provided relevant services for the last 2 years; and official documentation that all mental health/substance abuse treatment provider organizations: 1) comply with all local (city, county) and state requirements for licensing, accreditation, and certification; OR 2) official documentation from the appropriate agency of the applicable state, county, other governmental unit that licensing, accreditation, and certification requirements do not exist. (Official documentation is a copy of each service provider organizations license, accreditation, and certification. Documentation of accreditation will not be accepted in lieu of an organizations license. A statement by, or letter from, the applicant organization or from a provider organization attesting to compliance with licensing, accreditation and certification or that no licensing, accreditation, certification requirements exist does not constitute adequate documentation.) for tribes and tribal organizations only, official documentation that all participating mental health/substance abuse treatment provider organizations: 1) comply with all applicable tribal requirements for licensing, accreditation, and certification; OR 2) documentation from the tribe or other tribal governmental unit that licensing, accreditation, and certification requirements do not exist. _______________________________ _____________________ Signature of Authorized Representative Date Appendix E Funding Restrictions SAMHSA grant funds must be used for purposes supported by the program and may not be used to: Pay for any lease beyond the project period. Provide services to incarcerated populations (defined as those persons in jail, prison, detention facilities, or in custody where they are not free to move about in the community). Pay for the purchase or construction of any building or structure to house any part of the program. (Applicants may request up to $75,000 for renovations and alterations of existing facilities, if necessary and appropriate to the project.) Provide residential or outpatient treatment services when the facility has not yet been acquired, sited, approved, and met all requirements for human habitation and services provision. (Expansion or enhancement of existing residential services is permissible.) Pay for housing other than residential mental health and/or substance abuse treatment. Provide inpatient treatment or hospital-based detoxification services. Residential services are not considered to be inpatient or hospital-based services. Only allowable costs associated with the use of federal funds are permitted to fund evidence-based practices (EBPs). Other sources of funds may be used for unallowable costs (e.g., meals, sporting events, entertainment). Other support is defined as funds or resources, whether federal, non-federal or institutional, in direct support of activities through fellowships, gifts, prizes, or in-kind contributions. Make direct payments to individuals to induce them to enter prevention or treatment services. However, SAMHSA discretionary grant funds may be used for non-clinical support services (e.g., bus tokens, child care) designed to improve access to and retention in prevention and treatment programs. Make direct payments to individuals to encourage attendance and/or attainment of prevention or treatment goals. However, SAMHSA discretionary grant funds may be used for non-cash incentives of up to $30 to encourage attendance and/or attainment of prevention or treatment goals when the incentives are built into the program design and when the incentives are the minimum amount that is deemed necessary to meet program goals. SAMHSA policy allows an individual participant to receive more than one incentive over the course of the program. However, non-cash incentives should be limited to the minimum number of times deemed necessary to achieve program outcomes. A grantee or treatment or prevention provider may also provide up to $30 cash or equivalent (coupons, bus tokens, gifts, child care, and vouchers) to individuals as incentives to participate in required data collection follow up. This amount may be paid for participation in each required interview. Meals are generally unallowable unless they are an integral part of a conference grant or specifically stated as an allowable expense in the RFA. Grant funds may be used for light snacks, not to exceed $2.50 per person. Funds may not be used to distribute sterile needles or syringes for the hypodermic injection of any illegal drug. Pay for pharmacologies for HIV antiretroviral therapy, sexually transmitted diseases (STD)/sexually transmitted illnesses (STI), TB, and hepatitis B and C, or for psychotropic drugs. SAMHSA will not accept a research indirect cost rate. The grantee must use the other sponsored program rate or the lowest rate available. Appendix F Biographical Sketches and Job Descriptions Biographical Sketch Existing curricula vitae of project staff members may be used if they are updated and contain all items of information requested below. You may add any information items listed below to complete existing documents. For development of new curricula vitae include items below in the most suitable format: Name of staff member Educational background: school(s), location, dates attended, degrees earned (specify year), major field of study Professional experience Honors received and dates Recent relevant publications Other sources of support [Other support is defined as all funds or resources, whether federal, non-federal, or institutional, available to the Project Director/Program Director (and other key personnel named in the application) in direct support of their activities through grants, cooperative agreements, contracts, fellowships, gifts, prizes, and other means.] Job Description Title of position Description of duties and responsibilities Qualifications for position Supervisory relationships Skills and knowledge required Personal qualities Amount of travel and any other special conditions or requirements Salary range Hours per day or week Appendix G Sample Budget and Justification (no match required) THIS IS AN ILLUSTRATION OF A SAMPLE DETAILED BUDGET AND NARRATIVE JUSTIFICATION WITH GUIDANCE FOR COMPLETING SF-424A: SECTION B FOR THE BUDGET PERIOD A. Personnel: Provide employee(s) (including names for each identified position) of the applicant/recipient organization, including in-kind costs for those positions whose work is tied to the grant project. FEDERAL REQUEST PositionNameAnnual Salary/RateLevel of EffortCost(1) Project DirectorJohn Doe$64,89010%$6,489(2) Grant CoordinatorTo be selected$46,276100%$46,276(3) Clinical DirectorJane DoeIn-kind cost20%0TOTAL$52,765 JUSTIFICATION: Describe the role and responsibilities of each position. The Project Director will provide daily oversight of the grant and will be considered key staff. The Coordinator will coordinate project services and project activities, including training, communication and information dissemination. The Clinical Director will provide necessary medical direction and guidance to staff for 540 clients served under this project. Key staff positions require prior approval by SAMHSA after review of credentials of resume and job description. FEDERAL REQUEST (enter in Section B column 1 line 6a of form S-424A) $52,765 B. Fringe Benefits: List all components that make up the fringe benefits rate FEDERAL REQUEST ComponentRateWageCostFICA7.65%$52,765 $4,037Workers Compensation2.5%$52,765 $1,319Insurance10.5%$52,765 $5,540TOTAL $10,896 JUSTIFICATION: Fringe reflects current rate for agency. FEDERAL REQUEST (enter in Section B column 1 line 6b of form SF-424A) $10,896 C. Travel: Explain need for all travel other than that required by this application. Local travel policies prevail. FEDERAL REQUEST Purpose of TravelLocationItemRateCost(1) Grantee Conference Washington, DCAirfare$200/flight x 2 persons$400Hotel$180/night x 2 persons x 2 nights$720Per Diem (meals and incidentals)$46/day x 2 persons x 2 days$184(2) Local travelMileage3,000 miles@.38/mile$1,140TOTAL$2,444 JUSTIFICATION: Describe the purpose of travel and how costs were determined. (1) Two staff (Project Director and Evaluator) to attend mandatory grantee meeting in Washington, DC. (2) Local travel is needed to attend local meetings, project activities, and training events. Local travel rate is based on organizations policies/procedures for privately owned vehicle reimbursement rate. If policy does not have a rate use GSA. FEDERAL REQUEST (enter in Section B column 1 line 6c of form SF-424A) $2,444 D. Equipment: An article of tangible, nonexpendable, personal property having a useful life of more than one year and an acquisition cost of $5,000 or more per unit (federal definition). FEDERAL REQUEST (enter in Section B column 1 line 6d of form SF-424A) $ 0 E. Supplies: Materials costing less than $5,000 per unit and often having one-time use FEDERAL REQUEST Item(s)RateCostGeneral office supplies$50/mo. x 12 mo.$600Postage$37/mo. x 8 mo.$296Laptop Computer$900$900Printer$300$300Projector$900$900Copies8000 copies x .10/copy$800TOTAL$3,796 JUSTIFICATION: Describe the need and include an adequate justification of how each cost was estimated. (1) Office supplies, copies and postage are needed for general operation of the project. (2) The laptop computer and printer are needed for both project work and presentations for Project Director. (3) The projector is needed for presentations and workshops. All costs were based on retail values at the time the application was written. FEDERAL REQUEST (enter in Section B column 1 line 6e of form SF-424A) $ 3,796 F. Contract: A contractual arrangement to carry out a portion of the programmatic effort or for the acquisition of routine goods or services under the grant. Such arrangements may be in the form of consortium agreements or contracts. A consultant is an individual retained to provide professional advice or services for a fee. The applicant/grantee must establish written procurement policies and procedures that are consistently applied. All procurement transactions shall be conducted in a manner to provide to the maximum extent practical, open and free competition. COSTS FOR CONTRACTS MUST BE BROKEN DOWN IN DETAIL AND A NARRATIVE JUSTIFICATION PROVIDED. IF APPLICABLE, NUMBERS OF CLIENTS SHOULD BE INCLUDED IN THE COSTS. FEDERAL REQUEST NameServiceRateOtherCost(1) State Department of Human ServicesTraining $250/individual x 3 staff5 days$750 (2) Treatment Services 1040 Clients $27/client per year$28,080(3) John Smith (Case Manager)Treatment Client Services 1FTE @ $27,000 + Fringe Benefits of $6,750 = $33,750 *Travel at 3,124 @ .50 per mile = $1,562 *Training course $175 *Supplies @ $47.54 x 12 months or $570 *Telephone @ $60 x 12 months = $720 *Indirect costs = $9,390 (negotiated with contractor) $46,167 (4) Jane Smith Evaluator$40 per hour x 225 hours12 month period $9,000(5) To Be AnnouncedMarketing Coordinator Annual salary of $30,000 x 10% level of effort $3,000TOTAL$86,997 JUSTIFICATION: Explain the need for each contractual agreement and how it relates to the overall project. Certified trainers are necessary to carry out the purpose of the statewide Consumer Network by providing recovery and wellness training, preparing consumer leaders statewide, and educating the public on mental health recovery. Treatment services for clients to be served based on organizational history of expenses. Case manager is vital to client services related to the program and outcomes. Evaluator is provided by an experienced individual (Ph.D. level) with expertise in substance abuse, research and evaluation, is knowledgeable about the population of focus, and will report GPRA data. Marketing Coordinator will develop a plan to include public education and outreach efforts to engage clients of the community about grantee activities, and provision of presentations at public meetings and community events to stakeholders, community civic organizations, churches, agencies, family groups and schools. *Represents separate/distinct requested funds by cost category FEDERAL REQUEST (enter in Section B column 1 line 6f of form SF-424A) $86,997 G. Construction: NOT ALLOWED Leave Section B columns 1& 2 line 6g on SF-424A blank. H. Other: Expenses not covered in any of the previous budget categories FEDERAL REQUEST ItemRateCost(1) Rent*$15/sq.ft x 700 sq. feet$10,500(2) Telephone$100/mo. x 12 mo.$1,200(3) Client Incentives$10/client follow up x 278 clients $2,780(4) Brochures.89/brochure X 1500 brochures$1,335TOTAL$15,815 JUSTIFICATION: Break down costs into cost/unit (e.g. cost/square foot). Explain the use of each item requested. (1) Office space is included in the indirect cost rate agreement; however, if other rental costs for service site(s) are necessary for the project, they may be requested as a direct charge. The rent is calculated by square footage or FTE and reflects SAMHSAs fair share of the space. *If rent is requested (direct or indirect), provide the name of the owner(s) of the space/facility. If anyone related to the project owns the building which is less than an arms length arrangement, provide cost of ownership/use allowance calculations. Additionally, the lease and floor plan (including common areas) is required for all projects allocating rent costs. (2) The monthly telephone costs reflect the percent of effort for the personnel listed in this application for the SAMHSA project only. (3) The $10 incentive is provided to encourage attendance to meet program goals for 278 client follow-ups. (4) Brochures will be used at various community functions (health fairs and exhibits). FEDERAL REQUEST (enter in Section B column 1 line 6h of form SF-424A) $15,815 Indirect Cost Rate: Indirect costs can be claimed if your organization has a negotiated indirect cost rate agreement. It is applied only to direct costs to the agency as allowed in the agreement. For information on applying for the indirect rate go to:  HYPERLINK "https://rates.psc.gov/fms/dca/map1.html" https://rates.psc.gov/fms/dca/map1.html. FEDERAL REQUEST (enter in Section B column 1 line 6j of form SF-424A) 8% of personnel and fringe (.08 x $63,661) $5,093 ================================================================== TOTAL DIRECT CHARGES: FEDERAL REQUEST (enter in Section B column 1 line 6i of form SF-424A) $172,713 INDIRECT CHARGES: FEDERAL REQUEST (enter in Section B column 1 line 6j of form SF-424A) $5,093 TOTAL: (sum of 6i and 6j) FEDERAL REQUEST (enter in Section B column 1 line 6k of form SF-424A) $177,806 ==================================================================Provide the total proposed project period and federal funding as follows: Proposed Project Period: Start Date: 09/30/2014 b. End Date: 09/29/2019 BUDGET SUMMARY (should include future years and projected total) CategoryYear 1Year 2*Year 3*Year 4*Year 5*Total Project CostsPersonnel$52,765$54,348$55,978$57,658$59,387$280,136Fringe$10,896$11,223$11,559$11,906$12,263$57,847Travel$2,444$2,444$2,444$2,444$2,444$12,220Equipment000000Supplies$3,796$3,796$3,796$3,796$3,796$18,980Contractual$86,997$86,997$86,997$86,997$86,997$434,985Other$15,815$13,752$11,629$9,440$7,187$57,823Total Direct Charges$172,713$172,560$172,403$172,241$172,074$861,991Indirect Charges$5,093$5,246$5,403$5,565$5,732$27,039Total Project Costs$177,806$177,806$177,806$177,806$177,806$889,030 TOTAL PROJECT COSTS: Sum of Total Direct Costs and Indirect Costs FEDERAL REQUEST (enter in Section B column 1 line 6k of form SF-424A) $889,030 *FOR REQUESTED FUTURE YEARS: 1. Please justify and explain any changes to the budget that differs from the reflected amounts reported in the 01 Year Budget Summary. 2. If a cost of living adjustment (COLA) is included in future years, provide your organizations personnel policy and procedures that state all employees within the organization will receive a COLA. IN THIS SECTION, REFLECT OTHER FEDERAL AND NON-FEDERAL SOURCES OF FUNDING BY DOLLAR AMOUNT AND NAME OF FUNDER e.g., Applicant, State, Local, Other, Program Income, etc. Other support is defined as funds or resources, whether federal, non-federal or institutional, in direct support of activities through fellowships, gifts, prizes, in-kind contributions or non-federal means. [Note: Please see  HYPERLINK \l "_Appendix_F__1" Appendix E, Funding Restrictions, regarding allowable costs.] IN THIS SECTION, include a narrative and separate budget for each year of the grant that shows that no more than 50 percent of the total grant award will be used for infrastructure development, including data collection, performance measurement and performance assessment and that no less than 50 percent of the total grant award be used for services. Infrastructure DevelopmentYear 1Year 2Year 3Year 4Year 5Total Infra-structure CostsPersonnel$2,250$2,250$2,250$2,250$2,250$11,250Fringe$558$558$558$558$558$2,790Travel000000Equipment$15,0000000$15,000Supplies$1,575$1,575$1,575$1,575$1,575$7,875Contractual$5,000$5,000$5,000$5,000$5,000$25,000Other$1,617$2,375$2,375$2,375$2,375$11,117Total Direct Charges$6,000$11,758$11,758$11,758$11,758$53,072Indirect Charges$750$750$750$750$750$3,750Total Infrastructure Costs$6750$12,508$12,508$12,508$12,508$56,782 Data Collection & Performance MeasurementYear 1Year 2Year 3Year 4Year 5Total Data Collection & Performance Measurement CostsPersonnel$6,700$6,700$6,700$6,700$6,700$33,500Fringe$2,400$2,400$2,400$2,400$2,400$12,000Travel$100$100$100$100$100$500Equipment000000Supplies$750$750$750$750$750$3,750Contractual$24,950$24,950$24,950$24,950$24,950$124,750Other000000Total Direct Charges$34,300$34,300$34,300$34,300$34,300$171,500Indirect Charges$698$698$698$698$698$3,490Data Collection & Performance Measurement$34,900$34,900$34,900$34,900$34,900$174,500 Appendix H Confidentiality and SAMHSA Participant Protection/Human Subjects Guidelines Confidentiality and Participant Protection: Because of the confidential nature of the work in which many SAMHSA grantees are involved, it is important to have safeguards protecting individuals from risks associated with their participation in SAMHSA projects. All applicants (including those who plan to obtain IRB approval) must address the seven elements below. Be sure to discuss these elements as they pertain to on-line counseling (i.e., telehealth) if they are applicable to your program. If some are not applicable or relevant to the proposed project, simply state that they are not applicable and indicate why. In addition to addressing these seven elements, read the section that follows entitled Protection of Human Subjects Regulations to determine if the regulations may apply to your project. If so, you are required to describe the process you will follow for obtaining Institutional Review Board (IRB) approval. While we encourage you to keep your responses brief, there are no page limits for this section and no points will be assigned by the Review Committee. Problems with confidentiality, participant protection, and the protection of human subjects identified during peer review of the application must be resolved prior to funding. Protect Clients and Staff from Potential Risks Identify and describe any foreseeable physical, medical, psychological, social, and legal risks or potential adverse effects as a result of the project itself or any data collection activity. Describe the procedures you will follow to minimize or protect participants against potential risks, including risks to confidentiality. Identify plans to provide guidance and assistance in the event there are adverse effects to participants. Where appropriate, describe alternative treatments and procedures that may be beneficial to the participants. If you choose not to use these other beneficial treatments, provide the reasons for not using them. Fair Selection of Participants Describe the population(s) of focus for the proposed project. Include age, gender, and racial/ethnic background and note if the population includes homeless youth, foster children, children of substance abusers, pregnant women, or other targeted groups. Explain the reasons for including groups of pregnant women, children, people with mental disabilities, people in institutions, prisoners, and individuals who are likely to be particularly vulnerable to HIV/AIDS. Explain the reasons for including or excluding participants. Explain how you will recruit and select participants. Identify who will select participants. Absence of Coercion Explain if participation in the project is voluntary or required. Identify possible reasons why participation is required, for example, court orders requiring people to participate in a program. If you plan to compensate participants, state how participants will be awarded incentives (e.g., money, gifts, etc.). Provide justification that the use of incentives is appropriate, judicious, and conservative and that incentives do not provide an undue inducement which removes the voluntary nature of participation. Incentives should be the minimum amount necessary to meet the programmatic and performance assessment goals of the grant. Applicants should determine the minimum amount that is proven effective by consulting with existing local programs and reviewing the relevant literature. In no case may the value if an incentive paid for with SAMHSA discretionary grant funds exceed $30. State how volunteer participants will be told that they may receive services intervention even if they do not participate in or complete the data collection component of the project. Data Collection Identify from whom you will collect data (e.g., from participants themselves, family members, teachers, others). Describe the data collection procedures and specify the sources for obtaining data (e.g., school records, interviews, psychological assessments, questionnaires, observation, or other sources). Where data are to be collected through observational techniques, questionnaires, interviews, or other direct means, describe the data collection setting. Identify what type of specimens (e.g., urine, blood) will be used, if any. State if the material will be used just for evaluation or if other use(s) will be made. Also, if needed, describe how the material will be monitored to ensure the safety of participants. Provide in Attachment 2, Data Collection Instruments/Interview Protocols, copies of all available data collection instruments and interview protocols that you plan to use. Privacy and Confidentiality Explain how you will ensure privacy and confidentiality. Include who will collect data and how it will be collected. Describe: How you will use data collection instruments. Where data will be stored. Who will or will not have access to information. How the identity of participants will be kept private, for example, through the use of a coding system on data records, limiting access to records, or storing identifiers separately from data. NOTE: If applicable, grantees must agree to maintain the confidentiality of alcohol and drug abuse client records according to the provisions of Title 42 of the Code of Federal Regulations, Part II. Adequate Consent Procedures List what information will be given to people who participate in the project. Include the type and purpose of their participation. Identify the data that will be collected, how the data will be used and how you will keep the data private. State: Whether or not their participation is voluntary. Their right to leave the project at any time without problems. Possible risks from participation in the project. Plans to protect clients from these risks. Explain how you will get consent for youth, the elderly, people with limited reading skills, and people who do not use English as their first language. NOTE: If the project poses potential physical, medical, psychological, legal, social or other risks, you must obtain written informed consent. Indicate if you will obtain informed consent from participants or assent from minors along with consent from their parents or legal guardians. Describe how the consent will be documented. For example: Will you read the consent forms? Will you ask prospective participants questions to be sure they understand the forms? Will you give them copies of what they sign? Include, as appropriate, sample consent forms that provide for: (1) informed consent for participation in service intervention; (2) informed consent for participation in the data collection component of the project; and (3) informed consent for the exchange (releasing or requesting) of confidential information. The sample forms must be included in Attachment 3, Sample Consent Forms, of your application. If needed, give English translations. NOTE: Never imply that the participant waives or appears to waive any legal rights, may not end involvement with the project, or releases your project or its agents from liability for negligence. Describe if separate consents will be obtained for different stages or parts of the project. For example, will they be needed for both participant protection in treatment intervention and for the collection and use of data? Additionally, if other consents (e.g., consents to release information to others or gather information from others) will be used in your project, provide a description of the consents. Will individuals who do not consent to having individually identifiable data collected for evaluation purposes be allowed to participate in the project? Risk/Benefit Discussion Discuss why the risks are reasonable compared to expected benefits and importance of the knowledge from the project. Protection of Human Subjects Regulations SAMHSA expects that most grantees funded under this announcement will not have to comply with the Protection of Human Subjects Regulations (45 CFR 46), which requires Institutional Review Board (IRB) approval. However, in some instances, the applicants proposed performance assessment design may meet the regulations criteria for research involving human subjects. For assistance in determining if your proposed performance assessment meets the criteria in 45 CFR 46, Protection of Human Subjects Regulations, refer to the SAMHSA decision tree on the SAMHSA website, under Applying for a New SAMHSA Grant,  HYPERLINK "http://beta.samhsa.gov/grants/applying" http://beta.samhsa.gov/grants/applying HYPERLINK "http://www.samhsa.gov/grants/apply.aspx" . In addition to the elements above, applicants whose projects must comply with the Human Subjects Regulations must fully describe the process for obtaining IRB approval. While IRB approval is not required at the time of grant award, these grantees will be required, as a condition of award, to provide documentation that an Assurance of Compliance is on file with the Office for Human Research Protections (OHRP). IRB approval must be received in these cases prior to enrolling participants in the project. General information about Human Subjects Regulations can be obtained through OHRP at  HYPERLINK "http://www.hhs.gov/ohrp" http://www.hhs.gov/ohrp, or ohrp@osophs.dhhs.gov, or (240) 453-6900. SAMHSAspecific questions should be directed to the program contact listed in  HYPERLINK \l "_VII._AGENCY_CONTACTS" Section VII of this announcement. Appendix I Addressing Behavioral Health Disparities In April 2011, the Department of Health and Human Services (HHS) released its Action Plan to Reduce Racial and Ethnic Health Disparities. This plan outlines goals and actions HHS agencies, including SAMHSA, will take to reduce health disparities among racial and ethnic minorities. Agencies are required to continuously assess the impact of their policies and programs on health disparities. The Action Plan is available at:  HYPERLINK "http://minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf" http://minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf. The number one Secretarial priority in the Action Plan is to: Assess and heighten the impact of all HHS policies, programs, processes, and resource decisions to reduce health disparities. Grantees for this program will be required to submit a health disparities impact statement to identify subpopulations (i.e., racial, ethnic, sexual/gender minority groups) vulnerable to health disparities. This statement must outline the population/s of focus that will be involved in the project and the unduplicated number of individuals who are expected to receive services. It should be consistent with information in your application regarding access, service use and outcomes for the program. The disparities impact statement may be developed as a brief narrative or table (see Sample Health Disparities Impact Statement at the end of this appendix). You also will be required to implement a data-driven quality improvement plan to decrease the differences in access, service use and outcomes among subpopulations that will be implemented throughout the project. This plan should include use of the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care. Definition of Health Disparities: Healthy People 2020 defines a health disparity as a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion. Subpopulations SAMHSA grant applicants are routinely asked to define the population they intend to serve given the focus of a particular grant program (e.g., adults with serious mental illness [SMI] at risk for chronic health conditions; young adults engaged in underage drinking; populations at risk for contracting HIV/AIDS, etc.). Within these populations of focus are subpopulations that may have disparate access to, use of, or outcomes from provided services. These disparities may be the result of differences in language, beliefs, norms, values, and/or socioeconomic factors specific to that subpopulation. For instance, Latino adults with SMI may be at heightened risk for metabolic disorder due to lack of appropriate in-language primary care services; Native American youth may have an increased incidence of underage drinking due to coping patterns related to historical trauma within the Native American community; and African American women may be at greater risk for contracting HIV/AIDS due to lack of access to education on risky sexual behaviors in urban low-income communities. While these factors might not be pervasive among the general population served by a grantee, they may be predominant among subpopulations or groups vulnerable to disparities. It is imperative that grantees understand who is being served within their community in order to provide care that will yield positive outcomes, per the focus of that grant. In order for organizations to attend to the potentially disparate impact of their grant efforts, applicants are asked to address access, use and outcomes for subpopulations, which can be defined by the following factors: By race By ethnicity By gender (including transgender), as appropriate By sexual orientation (i.e., lesbian, gay, bisexual), as appropriate HHS published final standards for data collection on race, ethnicity, sex, primary language and disability status, as required by Section 4302 of the Affordable Care Act in October 2011,  HYPERLINK "http://www.minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlid=208" http://www.minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlid=208. The ability to address the quality of care provided to subpopulations served within SAMHSAs grant programs is enhanced by programmatic alignment with the federal CLAS standards. National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care The National CLAS standards were initially published in the Federal Register on December 22, 2000. Culturally and linguistically appropriate health care and services, broadly defined as care and services that are respectful of and responsive to the cultural and linguistic needs of all individuals, is increasingly seen as essential to reducing disparities and improving health care quality. The National CLAS Standards have served as catalyst and conduit for the evolution of the field of cultural and linguistic competency over the course of the last 12 years. In recognition of these changes in the field, the HHS Office of Minority Health undertook the National CLAS Standards Enhancement Initiative from 2010 to 2012. The enhanced National CLAS Standards seek to set a new bar in improving the quality of health to our nations ever diversifying communities. Enhancements to the National CLAS Standards include the broadening of the definitions of health and culture, as well as an increased focus on institutional governance and leadership. The enhanced National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care are comprised of 15 Standards that provide a blueprint for health and health care organizations to implement culturally and linguistically appropriate services that will advance health equity, improve quality, and help eliminate health care disparities. You can learn more about the CLAS mandates, guidelines, and recommendations at:  HYPERLINK "http://www.ThinkCulturalHealth.hhs.gov" http://www.ThinkCulturalHealth.hhs.gov. Sample Health Disparities Impact Statement: Proposed number of individuals to be served by subpopulations in the geographic area Access: The numbers in the chart below reflect the proposed number of individuals to be served during the grant period and all identified subpopulations in the geographic area. The disparate populations are highlighted in the narrative below. FY 1FY 2FY 3FY 4TotalsDirect Services: Number to be served200175100125600By Race/EthnicityAfrican American1095630American Indian/Alaska Native11013Asian22116White (non-Hispanic)103915265311Hispanic or Latino (not including Salvadoran)3228162096 Salvadoran44372228130Native Hawaiian/Other Pacific Islander432211Two or more Races442313By GenderFemale110965569330Male89794456268Transgender10102By Sexual Orientation/Identity Status Lesbian22116Gay864523Bisexual11013The population of Middle Lake, Massachusetts is predominantly represented by first- and second-generation Latino immigrants, mainly from El Salvador. There has been a recent increase of the immigrant population in the city with individuals primarily from Haiti and El Salvador. There is also a smaller Cambodian and African American population in the city. Nearly 40% of residents speak a language other than English in their homes, and a majority of those individuals are Spanish speakers. There is a high unemployment rate, low literacy rate and high level of poverty, in particular among the Salvadoran subpopulation, putting these individuals at greater risk for behavioral health issues when compared to national trends. However, our agency has served relatively low numbers of Salvadorans. Therefore, we have chosen to focus our efforts on the Salvadoran subpopulation. A Quality Improvement Plan Using Our Data Use: Services and activities will be designed and implemented in accordance with the cultural and linguistic needs of individuals in the community. The project team will collaborate with the community enrichment program and the county health specialist consortium in planning the design and implementation of program activities to ensure the cultural and linguistic needs of grant participants are effectively addressed, particularly the disparate population. A continuous quality improvement approach will be used to analyze, assess and monitor key performance indicators as a mechanism to ensure high-quality and effective program operations. Program data will be used to monitor and manage program outcomes by race, ethnicity, and LGBT status within a quality improvement process. Programmatic adjustments will be made as indicated to address identified issues, including behavioral health disparities, across program domains. A primary objective of the data collection and reporting will be to monitor/measure project activities in a manner that optimizes the usefulness of data for project staff and consumers; evaluation findings will be integrated into program planning and management on an ongoing basis (a self-correcting model of evaluation). For example, referral to enrollment, treatment completion and discharge data will be reported to staff on an ongoing basis, including analyses and discussions of who may be more or less likely to enroll and complete the program (and possible interventions). The Evaluator will meet on a bi-weekly basis with staff, providing an opportunity for staff to identify successes and barriers encountered in the process of project implementation. These meetings will be a forum for discussion of evaluation findings, allowing staff to adjust or modify project services to maximize project success. Outcomes for all services and supports will be monitored across race and ethnicity to determine the grants impact on behavioral health disparities. Adherence to the CLAS Standards Our quality improvement plan will ensure adherence to the enhanced National Standards for Culturally and Linguistically Appropriate Services (CLAS Standards) in Health and Health Care. This will include attention to: Diverse cultural health beliefs and practices Training and hiring protocols will be implemented to support the culture and language of all subpopulations, with a focus on the Salvadoran subpopulation. Preferred languages Interpreters and translated materials will be used for non-English speaking clients as well as those who speak English, but prefer materials in their primary language. Key documents will be translated into Spanish. Health literacy and other communication needs of all sub-populations identified in your proposal All services programs will be tailored to include limited English proficient individuals. Staff will receive training to ensure capacity to provide services that are culturally and linguistically appropriate. Appendix J Electronic Health Record (EHR) Resources The following is a list of websites for EHR information: For additional information on EHR implementation please visit:  HYPERLINK "http://www.healthit.gov/providers-professionals" http://www.healthit.gov/providers-professionals For a comprehensive listing of Complete EHRs and EHR Modules that have been tested and certified under the Temporary Certification Program maintained by the Office of the National Coordinator for Health IT (ONC) please see:  HYPERLINK "http://onc-chpl.force.com/ehrcert" http://onc-chpl.force.com/ehrcert For a listing of Regional Extension Centers (REC) for technical assistance, guidance, and information to support efforts to become a meaningful user of Electronic Health Records (EHRs), see:  HYPERLINK "http://www.healthit.gov/providers-professionals/regional-extension-centers-recs" \l "listing" http://www.healthit.gov/providers-professionals/regional-extension-centers-recs#listing Behavioral healthcare providers should also be aware of federal confidentiality regulations including HIPPA and 42CRF Part 2 ( HYPERLINK "http://www.samhsa.gov/HealthPrivacy/" http://www.samhsa.gov/HealthPrivacy/). EHR implementation plans should address compliance with these regulations. For questions on EHRs and HIT, contact:  HYPERLINK "mailto:SAMHSA.HIT@samhsa.hhs.gov" SAMHSA.HIT@samhsa.hhs.gov.  Tribes and tribal organizations are exempt from these requirements.  Tribes and tribal organizations are exempt from these requirements.     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_Toc384922614_1._ELIGIBLE_APPLICANTS _Toc384922615_2._COST_SHARING _Toc384922616 _Toc384922617 _Toc197933196 _Toc197933197 _Toc228844875 _Toc384922618_2.2_Required_Application _Toc384922619 _Toc197933202_1.1_Required_Application _Toc197933203_3._SUBMISSION_DATES_3._APPLICATION_SUBMISSION _Toc384922620_4._INTERGOVERNMENTAL_REVIEW$_5._FUNDING_LIMITATIONS/RESTRICTIONS$_4._FUNDING_LIMITATIONS/RESTRICTIONS _Toc384922621_6._OTHER_SUBMISSION_V._APPLICATION_REVIEW _Toc384922622_1._EVALUATION_CRITERIA _Toc384922623 _Toc197933212 _Toc197933213_Section_B:_Proposed _Toc197933214 _Toc197933215_Section_E:_Data _Toc197933216_Section_F:_Electronic_SUPPORTING_DOCUMENTATION _Toc197933217 _Toc228844885 _Toc265249662 _Toc266262539 _Toc266802924 _Toc197933218 _Toc197933220 _Toc384922624 _Toc384922625 _Toc384922626 _Toc384922627 _Toc384922628_VII._AGENCY_CONTACTS _Toc384922629_Appendix_A_ _1_Appendix_A_ _ _Appendix_A_ _Toc384922630_Appendix_B_ _ _Appendix_B_ _Toc384922631 _Appendix_C_ _Appendix_C_ _1 _Toc384922632 _Toc280258979 _Toc317150069_Appendix_D_ _ _Toc384922633 _Appendix_E_ _Appendix_D_ _Toc384922634 _Appendix_H_ _Appendix_G_ _1_Appendix_I_ _1 _Appendix_F_ _Appendix_G_ _Toc384922635 _Toc197933241 _Toc197933242 _Toc198626992 _Toc277844286 _Toc384922636 _Toc198626993 _Toc266800788 _Toc266802838 _Toc266803127 _Toc266955506 _Toc280258986 _Toc306973092 _Toc317150077 _Toc318707614 _Toc280258987 _Toc306973093 _Toc317150078 _Toc318707615 _Toc280258988 _Toc306973094 _Toc317150079 _Toc318707616 _Toc280258989 _Toc306973095 _Toc317150080 _Toc318707617 _Toc280258990 _Toc306973096 _Toc317150081 _Toc318707618 _Toc280258991 _Toc306973097 _Toc317150082 _Toc318707619 _Toc342484289 _Toc280258992 _Toc306973098 _Toc317150083 _Toc318707620 _Toc280258993 _Toc306973099 _Toc317150084 _Toc318707621 _Toc280258994 _Toc306973100 _Toc317150085 _Toc318707622 _Toc280258995 _Toc306973101 _Toc317150086 _Toc318707623 _Toc280258996 _Toc306973102 _Toc317150087 _Toc318707624 _Toc280258997 _Toc306973103 _Toc317150088 _Toc318707625 _Toc280258998 _Toc306973104 _Toc317150089 _Toc318707626 _Toc280258999 _Toc306973105 _Toc317150090 _Toc318707627 _Toc280259000 _Toc306973106 _Toc317150091 _Toc318707628 _Toc280259001 _Toc306973107 _Toc317150092 _Toc318707629 _Toc280259002 _Toc306973108 _Toc317150093 _Toc318707630 _Toc280259003 _Toc306973109 _Toc317150094 _Toc318707631 _Toc280259004 _Toc306973110 _Toc317150095 _Toc318707632 _Toc280259005 _Toc306973111 _Toc317150096 _Toc318707633 _Toc280259006 _Toc306973112 _Toc317150097 _Toc318707634 _Toc280259007 _Toc306973113 _Toc317150098 _Toc318707635 _Toc280259008 _Toc306973114 _Toc317150099 _Toc318707636 _Toc280259009 _Toc306973115 _Toc317150100 _Toc318707637 _Toc90713308 _Toc93133740 _Toc93133798 _Toc93134310 _Toc90713309 _Toc93133741 _Toc93133799 _Toc93134311 _Toc280259010 _Toc306973116 _Toc317150101 _Toc318707638 _Toc280259011 _Toc306973117 _Toc317150102 _Toc318707639 _Toc280259012 _Toc306973118 _Toc317150103 _Toc318707640 _Toc90713311 _Toc93133743 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