Transcript Substance Abuse Prevention and Treatment Block Grant Overview

WELCOME
Substance Abuse Prevention and
Treatment Block Grant Overview
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment
www.samhsa.gov
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History and Intent of the
Substance Abuse Prevention
and Treatment Block Grant
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History and Intent of the Substance Abuse Prevention
and Treatment Block Grant
Public Law 97-35 (PL 97-35) created the
Alcohol, Drug Abuse and Mental Health
Services (ADMS) Block Grant.
PL 97-35 became effective on October 1,
1981.
In addition to funding alcohol and drug
services, the ADMS Block Grant included
funds for mental health services.
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History and Intent of the Substance Abuse Prevention
and Treatment Block Grant
The ADAMHA Reorganization Act (Public
Law 102-321, 102d Congress) of 1992 created
several significant changes in the Block Grant,
including the following:
It created a distinct block grant for mental health
services and a distinct block grant for substance
abuse services.
It changed the name of the portion of the Block
Grant for alcohol and drug services to the
Substance Abuse Prevention and Treatment
(SAPT) Block Grant.
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History and Intent of the Substance Abuse Prevention
and Treatment Block Grant
The current Block Grant regulations were released in
the Federal Register in March 1993.
The official citation of the current regulations is
Title 45 of the Code of Federal Regulations Part 96
(45 CFR Part 96), Substance Abuse Prevention and
Treatment Block Grants; Interim Final Rule.
The regulations authorize the Secretary of the
Department of Health and Human Services (DHHS)
to provide Block Grants to States for the purpose
of planning, carrying out, and evaluating activities
to prevent and treat substance abuse.
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History and Intent of the Substance Abuse Prevention
and Treatment Block Grant
The SAPT Block Grant also incorporates
provisions from each of the following:
The Tobacco Regulation for Substance Abuse
Prevention and Treatment Block Grants, otherwise
known as the “Synar” regulations, published in the
Federal Register in January 1996.
The Office of Management and Budget (OMB)
Circular A-133.
The Charitable Choice final rules published in the
Federal Register on September 30, 2003.
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History and Intent of the Substance Abuse Prevention
and Treatment Block Grant
The Children’s Health Act of 2000 altered the
following SAPT Block Grant requirements:
States are no longer required to spend a minimum
of 35 percent of their Block Grant funds
specifically on drug-related activities and a
minimum of 35 percent on alcohol-related
activities.
States do not have to maintain a $100,000
revolving loan fund to support homes for persons
recovering from substance abuse—this is now
optional.
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History and Intent of the Substance Abuse Prevention
and Treatment Block Grant
States may allocate Block Grant funds to faithbased treatment programs that maintain their
religious character and hire people of their same
faith.
The Secretary may exempt from maintenance of
effort requirements any one-time infusion of funds
that are used for a single purpose.
The Children’s Health Act also required that by
2002 the Secretary submit to Congress a plan
that outlines how the Block Grant program will
become a performance-based system.
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History and Intent of the Substance Abuse Prevention
and Treatment Block Grant
Block Grant recipients must adhere to
SAMHSA’s National Outcome Measures
(NOMs).
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§ 96.122 Application Content and
Procedures and § 96.123 Assurances
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§ 96.122 Application Content and Procedures and § 96.123 Assurances
Block Grant recipients include each of the
50 States, each U.S. territory, the District
of Columbia, and the Red Lake Band of
Chippewa Indians of Minnesota.
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§ 96.122 Application Content and Procedures and § 96.123 Assurances
The Block Grant application requires States to
complete standard forms, tables, and narrative
sections, including:
An annual report that describes the amounts of
Block Grant expenditures and the activities funded
by the grant
A State Plan outlining the intended use of SAPT
Block Grant funds, including how the State will
comply with the Block Grant requirements
Assurances that the State will comply with the
Block Grant requirements as well as other
applicable Federal requirements
12
§ 96.133 Submission to Secretary of
Statewide Assessment of Needs
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§ 96.133 Submission to Secretary of Statewide Assessment of Needs
States are required to submit an assessment
of statewide and locality-specific need for
authorized [Block Grant] activities.
The needs assessment must include the
incidence and prevalence of drug abuse,
alcohol abuse, and alcoholism.
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§ 96.133 Submission to Secretary of Statewide Assessment of Needs
Incidence and prevalence data must be
obtained using generally accepted research
methods.
“Incidence” refers to the number of new cases that
emerge with a given period of time.
“Prevalence” refers to the total number of cases at
a given moment in time.
Social indicator studies and household surveys are
examples of generally accepted research methods.
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§ 96.133 Submission to Secretary of Statewide Assessment of Needs
State and sub-State data have to be collected
and reported by:
Age
Sex
Race/ethnicity
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§ 96.133 Submission to Secretary of Statewide Assessment of Needs
Data must include five substance abuse
problems:
Marijuana (including hashish)
Cocaine (including crack)
Hallucinogens (including PCP)
Heroin
Alcohol
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§ 96.133 Submission to Secretary of Statewide Assessment of Needs
States should also use common diagnostic
criteria (e.g., DSM criteria) to measure
dependence.
States must provide detailed descriptions of:
Current prevention and treatment activities
Intended use of prevention and treatment funds
Treatment capacity
Primary prevention activities must be broken
down by strategies used and other
characteristics outlined in the Block Grant
regulations.
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§ 96.133 Submission to Secretary of Statewide Assessment of Needs
Primary prevention strategies should be
appropriate for each target group and include,
but not be limited to, approaches such as:
Information dissemination
Education
Alternatives
Problem identification and referral
Community-based processes
Environmental strategies
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§ 96.133 Submission to Secretary of Statewide Assessment of Needs
States must identify the entities that provide
prevention and treatment services, and they
must describe those services.
States must submit information on treatment
utilization that describes the type of care and
utilization by primary diagnoses of:
Alcohol abuse
Drug abuse
A combination of alcohol and drug abuse
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§ 96.133 Submission to Secretary of Statewide Assessment of Needs
States must describe efforts to improve
substance abuse treatment and prevention
activities, including:
Strategies used to improve existing programs
New programs created
Actions taken to remove barriers
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§ 96.134 Maintenance of Effort
Regarding State Expenditures
22
§ 96.134 Maintenance of Effort Regarding State Expenditures
The Principal State Agency for substance
abuse prevention and treatment must maintain
aggregate State expenditures for authorized
activities at a level that is not less than the
average level of such expenditures for the
preceding 2 State fiscal-year periods.
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' 96.124 Certain Allocations
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' 96.124 Certain Allocations
Special Services for Pregnant Women and
Women with Dependent Children
States were required to establish a base of
expenditures for special treatment services for
pregnant women and women with dependent
children.
Women with dependent children include
women who are attempting to regain custody
of those children.
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' 96.124 Certain Allocations
Special Services for Pregnant Women and Women with Dependent Children
States must ensure that programs that receive
funds set aside for pregnant women and
women with dependent children provide or
arrange for:
Primary medical care, including prenatal care
Primary pediatric care for the women=s children,
including immunizations
Gender-specific substance abuse treatment
Other therapeutic interventions for women
addressing issues such as relationships, sexual
and physical abuse, and parenting
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' 96.124 Certain Allocations
Special Services for Pregnant Women and Women with Dependent Children
Therapeutic interventions for children in custody
of women in treatment to address, among other
things, developmental needs, sexual abuse,
physical abuse, and neglect
Child care while the women are receiving
services
Sufficient case management and transportation
to ensure that the women and their children have
access to the above services
States must also require programs that receive
this set-aside to treat the family as a unit and
therefore admit both women and their
children into treatment, when appropriate.
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' 96.124 Certain Allocations
Special Services for Pregnant Women and Women with Dependent Children
The Secretary also strongly encourages States
to require programs that receive these setaside funds to provide or arrange for the
following additional services:
Case management to assist in establishing
eligibility for public assistance programs
provided by Federal, State, or local governments
Employment and training programs
Education and special education programs
Drug-free housing for women and their children
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' 96.124 Certain Allocations
Special Services for Pregnant Women and Women with Dependent Children
Therapeutic day care, Head Start, and other early
childhood programs for children
Block Grant-funded programs must use the
Block Grant as the “payment of last resort”
and only for those who have no other
financial means for obtaining services for
pregnant women and women with dependent
children.
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' 96.124 Certain Allocations
Calculating the Required Expenditure Level
for Services for Pregnant Women and Women
with Dependent Children
By Federal fiscal year 1994 (October 1, 1993–
September 30, 1994), States were required to
establish base expenditure levels for services
for pregnant women and women with
dependent children.
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§ 96.131 Treatment Services
for Pregnant Women
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§ 96.131 Treatment Services for Pregnant Women
States must require all Block Grant-funded
programs to give pregnant women preference
in admissions to treatment.
Programs that serve an injecting drug abuse
population must give preference to treatment
in the following order:
Pregnant injecting drug users first
Other pregnant substance abusers second
Other injecting drug users third
All others
32
§ 96.131 Treatment Services for Pregnant Women
States must also publicize the availability of
services for pregnant women, including the
fact that such women receive admissions
preference.
States must require Block Grant-funded
programs to refer pregnant women to the State
when such women cannot be admitted due to
insufficient capacity.
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§ 96.131 Treatment Services for Pregnant Women
For women referred to States because of lack
of capacity, States must:
Refer the women to programs with the capacity to
admit them or
Ensure that interim services, including prenatal
care, are made available to the women within 48
hours after the women seek treatment
34
§ 96.131 Treatment Services for Pregnant Women
Therefore, States must maintain:
A continually updated system for identifying
treatment capacity for pregnant women who
cannot be admitted
A mechanism for matching such women to
treatment programs with sufficient capacity
States must also have effective strategies for
monitoring programs= compliance with this
section.
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§ 96.126 Capacity of Treatment for
Intravenous Substance Abusers
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§ 96.126 Capacity of Treatment for Intravenous Substance Abusers
Capacity Management System
States must establish capacity management
systems that enable and require programs that
provide treatment for intravenous drug abuse
to:
Readily report to the State when the programs
reach 90 percent of their capacities
Make such reports within 7 days
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§ 96.126 Capacity of Treatment for Intravenous Substance Abusers
Capacity Management System
The capacity management system should also
ensure that the State:
Is capable of maintaining a continually updated
record of reports of programs reaching 90 percent
of their capacities
Makes excess capacity information available to
Block Grant-funded programs that treat
intravenous substance abuse
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§ 96.126 Capacity of Treatment for Intravenous Substance Abusers
Capacity Management System
States must have a waiting list management
system that systematically reports treatment
demand and requires Block Grant-funded
programs that treat intravenous drug abuse to:
 Establish waiting lists with a unique client identifier for
each waiting list client
 Consult the State=s capacity management system to ensure
that waiting list clients are transferred to programs within a
reasonable geographic area at the earliest possible time
 Allow waiting list clients to be removed from the lists only
when they cannot be located or the clients refuse treatment
39
§ 96.126 Capacity of Treatment for Intravenous Substance Abusers
Capacity Management System
Block Grant-funded programs that treat
individuals for intravenous substance abuse must
admit each individual who requests and is in need
of treatment for intravenous drug abuse not later
than 14 days.
When programs cannot admit individuals for
intravenous substance abuse within 14 days, the
program must:
Admit these individuals within 120 days
 Have a mechanism for maintaining contact with
individuals awaiting admission
Make interim services available within 48 hours
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§ 96.126 Capacity of Treatment for Intravenous Substance Abusers
Capacity Management System
Interim services must include counseling and
education about:
 HIV and TB
The risks of needle sharing
 The risks of transmission to sexual partners
and infants
 Steps that can be taken to ensure that HIV
transmission does not occur
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§ 96.126 Capacity of Treatment for Intravenous Substance Abusers
Capacity Management System
Interim services must also include referrals for
HIV and TB services, if necessary.
For pregnant women, interim services should also
include referrals for prenatal care and counseling
on the effects of alcohol and drug use on the
fetus.
Interim services may also include federally
authorized methadone maintenance.
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Outreach
43
Outreach
States must ensure that entities that receive
Block Grant funds to treat intravenous
substance abuse conduct outreach activities to
encourage individuals in need of such services
to undergo treatment.
States must use outreach models that are
scientifically sound.
44
Outreach
The regulations identify three examples
of scientifically sound models:
The Standard Intervention model
The Health Education model
The Indigenous Leader model
If no models are applicable to the local
situation, the State can use an approach which
reasonably can be expected to be effective.
45
Outreach
States must ensure that outreach efforts:
 Consist of contacting, communicating with, and following
up with high-risk substance abusers, their associates, and
neighborhood residents
 Adhere to Federal and State confidentiality requirements
 Promote awareness about the relationship between injecting
drug abuse and communicable diseases
 Recommend steps that can be taken to prevent HIV
transmission
 Address the selection, training, and supervision of outreach
workers
 Encourage entry into treatment
46
§ 96.127 Requirements Regarding
Tuberculosis
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§ 96.127 Requirements Regarding Tuberculosis
Tuberculosis Services
States must require programs receiving funds
to treat substance abuse to routinely make TB
services available to each individual receiving
treatment for substance abuse.
Required TB services include:
Counseling individuals with respect to TB
TB testing
Appropriate medical evaluation and treatment for
individuals with TB
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§ 96.127 Requirements Regarding Tuberculosis
Tuberculosis Services
Programs can provide the required TB
services either directly or through
arrangements with other public or nonprofit
private entities.
The Principal State Agency must also
establish linkages with other health providers
to ensure that TB services are routinely made
available.
The Principal State Agency in consultation
with the primary State infectious disease
authority must have written procedures and
protocols to prevent the transmission of TB.
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§ 96.127 Requirements Regarding Tuberculosis
Tuberculosis Services
States must also require Block Grant-funded
treatment programs to implement infection control
procedures that are consistent with those
established by the Principal State Agency.
The infection control procedures must address how
programs:
 Screen patients and identify individuals who are at high risk
of becoming infected
 Meet all State reporting requirements while adhering to
Federal and State confidentiality requirements, including
42 CFR part 2
 Provide case management activities to ensure that individuals
receive TB services
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§ 96.127 Requirements Regarding Tuberculosis
Tuberculosis Services
When clients cannot be admitted to a program due to
lack of capacity, the program must refer such clients to
other providers of TB services.
States must develop effective strategies for monitoring
compliance with these requirements, particularly to
ensure that required services are being provided.
States must also:
 Use SAPT Block Grant funds as the Apayor of last resort@
for TB services
 Make reasonable efforts to determine eligibility and bill
and collect payment for services
51
§ 96.127 Requirements Regarding Tuberculosis
TB Maintenance of Effort
States were required to establish a base
expenditure level for State-appropriated funds
expended on TB services for individuals
receiving substance abuse treatment.
The base expenditure calculation is the
average of the 2 State fiscal years preceding
SFY93.
52
§ 96.127 Requirements Regarding Tuberculosis
TB Maintenance of Effort
Once the base is established, the State must
maintain this level of expenditures for each
year thereafter.
53
§ 96.128 Requirements Regarding Human
Immunodeficiency Virus
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§ 96.128 Requirements Regarding Human Immunodeficiency Virus
HIV Services
States with 10 or more HIV cases per 100,000
people are considered HIV Designated States.
Designated States must provide one or more
HIV early intervention projects at the sites at
which individuals are undergoing treatment
for substance abuse.
Your State is not currently an HIV Designated
State.
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§ 96.135 Restrictions on Expenditure
of the Grant
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§ 96.135 Restrictions on Expenditure of the Grant
States cannot expend the Block Grant to:
Provide inpatient hospital services except under
those conditions outlined in the regulations
Make cash payments to intended recipients of
health services
Purchase or improve land
Purchase, construct, or permanently improve
buildings or other facilities
Purchase major medical equipment
Satisfy any requirement for the expenditure of
non-Federal funds as a condition for the receipt of
Federal funds
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§ 96.135 Restrictions on Expenditure of the Grant
Provide financial assistance to any entity other
than a public or nonprofit private entity
Provide individuals with hypodermic needles or
syringes
Expend more than the amount of Block Grant
funds expended in FFY91 for treatment services
provided in penal or correctional institutions of the
State
States cannot expend more than 5 percent of
SAPT Block Grant funds to administer the
grant.
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§ 96.132 Additional Agreements
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§ 96.132 Additional Agreements
In their funding agreements with Block Grantfunded prevention and treatment programs,
States must ensure that such programs make
continuing education available to employees
who provide those services.
Principal State Agency must coordinate with
other appropriate services such as health,
social, correctional and criminal justice,
educational, vocational, and employment
service systems.
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§ 96.132 Additional Agreements
States can use methods such as the following
to demonstrate service coordination:
Memoranda of agreement
Inclusion of service coordination requirements in
grants and contracts
Principal State Agency and subrecipients of
Block Grant funds must have a system to
protect patient records from inappropriate
disclosure.
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§ 96.132 Additional Agreements
The systems that States and programs use
to protect clients records must:
Comply with all applicable State and
Federal laws and regulations, including 42
CFR part 2
Include provisions for employee education
on the confidentiality requirements and the
fact that disciplinary action may occur upon
inappropriate disclosures
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§ 96.136 Independent Peer Review
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§ 96.136 Independent Peer Review
States must have independent peer review
systems that assess the quality,
appropriateness, and efficacy of Block
Grant-funded treatment services.
The regulations define Quality as the
provision of treatment services that meet
accepted standards and practices that will
improve patient/client health and safety in
the context of recovery.
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§ 96.136 Independent Peer Review
The regulations define Appropriateness as
the provision of treatment services
consistent with each individual=s identified
clinical needs and level of functioning.
To determine quality and appropriateness
of treatment, reviews must include an
examination of a representative sample of
client/patient records.
65
§ 96.136 Independent Peer Review
In reviewing client/patient records, reviewers
will examine:
Admission criteria/intake processes
Assessments
Treatment planning
Documentation of implementation of treatment
strategies
Discharge and continuing care planning
Indications of treatment outcomes
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§ 96.136 Independent Peer Review
Independent peer reviewers must consist
of individuals who are:
Experts in the substance abuse field
Representative of the various disciplines used by
the program being reviewed
Knowledgeable about the modality being
reviewed and its underlying theoretical approach
to addictions treatment
Sensitive to the cultural and environmental issues
that may influence the quality of services being
provided
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§ 96.136 Independent Peer Review
Not providers/practitioners of the program under
review
Not individuals who have administrative
oversight of or authority to make funding
decisions about the program under review
The peer review system must review a
minimum of 5 percent of the State’s Block
Grant-funded treatment programs each year.
States must ensure that independent peer
review is not conducted as a part of the
program licensing/certification process.
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§ 96.129 Revolving Funds
for Establishment of Homes in Which
Recovering Substance Abusers May Reside
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§ 96.129 Revolving Funds for Establishment of Homes in Which Recovering
Substance Abusers May Reside
Before the Children’s Health Services Act
of 2000 was passed, States were required
to maintain a $100,000 revolving fund to
support homes for persons recovering from
substance abuse.
The Children’s Health Services Act makes
this provision optional.
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§ 96.129 Revolving Funds for Establishment of Homes in Which Recovering
Substance Abusers May Reside
Each loan:
Must be for homes of six or more people
Can only be made to private nonprofit entities
Cannot exceed $4,000
Must be repaid within 2 years
Has to be repaid in monthly installments
71
§ 96.129 Revolving Funds for Establishment of Homes in Which Recovering
Substance Abusers May Reside
Comes with the condition that alcohol or illegal
drug use must be prohibited in the home, and
residents who violate the conditions must be
expelled
Must require that residents pay the costs of
housing, including fees for rent and utilities
Must require the majority vote of residents to
establish policies governing the house
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§ 96.129 Revolving Funds for Establishment of Homes in Which Recovering
Substance Abusers May Reside
States must also:
Identify and define the purposes for which loan
funds will be spent
Set reasonable criteria for determining eligibility
of prospective borrowers
Establish procedures and a process for applying
for a loan
Provide clear written instructions to applicants
concerning what is expected of them
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§ 96.129 Revolving Funds for Establishment of Homes in Which Recovering
Substance Abusers May Reside
 Keep a written record of the number and amounts of loans
as well as the identities of borrowers and their repayment
history
 Establish reasonable criteria for selecting a fund
management group, if the State decides to delegate fund
management to a separate organization
The State and any entity managing the revolving
fund must abide by all Federal, State, and local laws
and regulations in managing the revolving fund.
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Other Applicable Requirements
75
Other Applicable Requirements
Single State Audit
The Office of Management and Budget
(OMB) Circular A-133 prescribes the
conditions under which non-Federal entities
must have single State and program-specific
audits.
According to OMB Circular A-133, a nonFederal entity that has $500,000 or more in
Federal expenditures during the entity=s fiscal
year must receive a single State audit.
76
Other Applicable Requirements
Single State Audit
A non-Federal entity with $500,000 or more
in Federal expenditures may elect to have a
program-specific audit if:
The expenditures are under only one Federal
program and
The Federal program does not require an A-133
audit
77
Other Applicable Requirements
Single State Audit
A non-Federal entity that expends less than
$500,000 in Federal awards during the
entity=s fiscal year:
Is exempt from Federal audit requirements for
that year
Must retain records to support expenditures and
must make those records available for review or
audit by appropriate officials of the Federal
agency, the pass-through entity, and the General
Accounting Office
78
Other Applicable Requirements
OMB A-133 Compliance Supplement
The OMB A-133 Compliance Supplement
identifies important compliance
requirements that the Federal Government
expects to be considered for each major
program that is audited under the auspices
of OMB A-133.
79
Other Applicable Requirements
OMB A-133 Compliance Supplement
One section of the Supplement specifically
addresses the audit requirements associated
with the SAPT Block Grant program
including:
Objectives and procedures for conducting an
A-133 audit of the Block Grant program
Objectives and suggested audit procedures for
determining compliance with SAPT Block
Grant requirements
80
Other Applicable Requirements
Subrecipient Monitoring
OMB A-133 defines recipients of Federal
Awards as “Pass-through Entities” and
“Subrecipients.”
A Pass-through Entity is a non-Federal entity
that receives a Federal award and passes
portions of it on to subrecipients to carry out a
Federal program.
A Subrecipient is a non-Federal entity that
expends Federal awards received from a passthrough entity to carry out a Federal program.
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Other Applicable Requirements
Subrecipient Monitoring
For example, when an Principal State Agency
subcontracts with programs to provide Block
Grant-funded prevention, treatment, and
rehabilitation services, the Principal State
Agency is the pass-through entity and
programs are subrecipients.
82
Other Applicable Requirements
Subrecipient Monitoring
OMB A-133 requires pass-through entities to:
Inform each subrecipient of Federal awards,
including the Catalogue of Federal Domestic
Assistance title and number, the award name and
number, and the award year
Convey requirements from Federal laws and
regulations, the provisions of contracts or grant
agreements, and any supplemental requirements
imposed by the pass-through entity
83
Other Applicable Requirements
Subrecipient Monitoring
Monitor subrecipients to ensure that Federal
awards are used for authorized purposes in
compliance with laws, regulations, and the
provisions of contracts or grant agreements and
that performance goals are achieved
Ensure that subrecipients meet applicable OMB
A-133 audit requirements
Issue management decisions on audit findings
within 6 months after receiving subrecipients'
audit reports
Ensure that the subrecipients take appropriate and
timely corrective action to resolve any audit
findings
84
Other Applicable Requirements
Subrecipient Monitoring
Determine if the subrecipient audits call for
adjustments in the pass-through entity's own
records
Require each subrecipient to permit the passthrough entity and auditors to have access to the
records and financial statements
85
Other Applicable Requirements
Fiscal Controls
States are exempt from the provisions of OMB
cost principle circulars; therefore, State cost
principle requirements apply to the SAPT
Block Grant instead.
86
Other Applicable Requirements
Salary Limitation
States and subrecipients cannot use the
Block Grant to pay salaries in excess of
Level I of the Federal Senior Executive
Service pay scale (e.g., no more than
$191,300 in 2008).
87
SAMHSA’s National Outcome Measures
SAMHSA’s National Outcome Measures
(NOMs)
All recipients of the following grants must
now comply with and report on the NOMs:
SAPT Block Grant
Community Mental Health Services Block Grant
CSAT, CSAP, and CMHS discretionary grants
88
SAMHSA’s National Outcome Measures
States must have systems in place to avoid
duplicated client counts.
At a minimum, such systems shall include the
following:
Recording admission and discharge information
for a client’s episode of care as a single record
Using a unique client identifier for each client
89
SAMHSA’s National Outcome Measures
Reduced Morbidity (Abstinence)
Outcome
Substance Abuse
Treatment Measures
Abstinence
from alcohol
and drug use
Reduction in/no change
in frequency of use at
date of last service
compared to date of first
service
Substance Abuse
Prevention Measures
1. 30-day substance use
(non-use/reduction)
2. Perceived risk/harm of
use
3. Age at first use
4. Perception of
disapproval
90
SAMHSA’s National Outcome Measures
Employment/Education
Outcome
Increased/retained
employment or
return to/stay in
school
Substance Abuse
Treatment Measures
Increased/no change
in number of
employed or in
school at date of last
service compared to
first service
Substance Abuse
Prevention Measures
1. Perception of workplace
policy
2. Alcohol, tobacco, and
drug-related
suspensions and
expulsions
3. Attendance and
enrollment
91
SAMHSA’s National Outcome Measures
Crime and Criminal Justice
Outcome
Substance Abuse
Treatment Measures
Substance Abuse
Prevention Measures
Decreased
Reduction in/no change in 1. Alcohol-related car
criminal justice number of arrests in past
crashes and injuries
involvement
30 days from date of first
service to date of last
2. Drug-related crime
service
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SAMHSA’s National Outcome Measures
Stability in Housing
Outcome
Increased stability
in housing
Substance Abuse
Treatment Measures
Substance Abuse
Prevention Measures
Increase in/no change in Not applicable
number of clients in
stable housing situation
from date of first service
to date of last service
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SAMHSA’s National Outcome Measures
Access/Capacity
Outcome
Substance Abuse
Treatment Measures
Increased access Unduplicated count of
to services
persons served;
(Service capacity) penetration rate—
numbers served
compared to those in
need
Substance Abuse
Prevention Measures
Number of persons
served by age, gender,
race, and ethnicity
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SAMHSA’s National Outcome Measures
Retention
Outcome
Increased
retention in
substance abuse
treatment
Substance Abuse
Treatment Measures
Substance Abuse
Prevention Measures
Length of stay from
1. Total number of evidencedate of first service to
based programs and
date of last service and
strategies
unduplicated count of
persons served
2. Percentage of youth
seeing, reading, watching,
or listening to a
prevention message
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SAMHSA’s National Outcome Measures
Social Connectedness
Outcome
Substance Abuse
Treatment
Measures
Substance Abuse
Prevention Measures
Increased social
Under development
supports/connectedness
Family communication
around drug use
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SAMHSA’s National Outcome Measures
Perception of Care
Outcome
Client perception
of care
Substance Abuse
Treatment Measures
Under development
Substance Abuse
Prevention Measures
Not applicable
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SAMHSA’s National Outcome Measures
Cost Effectiveness
Outcome
Cost
effectiveness
(average cost)
Substance Abuse
Treatment Measures
Substance Abuse
Prevention Measures
Number of States
Services provided within
providing substance
cost bands
abuse treatment within
approved cost-per-person
bands by the type of
treatment
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SAMHSA’s National Outcome Measures
Use of Evidence-Based Practices
Outcome
Substance Abuse
Treatment Measures
Use of
Under development
evidence-based
practices
Substance Abuse
Prevention Measures
Total number of evidencebased programs and
strategies
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Charitable Choice (45 CFR Part 54a)
According to Charitable Choice regulations,
Federal, State, and local governments that
receive funds under these programs cannot
discriminate against an organization that is, or
applies to be, a program participant on the
basis of the organization’s religious character
or affiliation.
Applicants for Block Grant funding must
certify that they will comply with all the
SAMHSA Charitable Choice requirements.
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Charitable Choice (45 CFR Part 54a)
Under Charitable Choice, Block Grant-funded
faith-based organizations:
Retain the authority over their internal governance
May retain religious terms in their organizations’
names
May select board members on a religious basis
May include religious references in the
organizations’ mission statements and other
governing documents
May use space in their facilities to offer Block
Grant-funded activities without removing
religious art, icons, scriptures, or other symbols
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Charitable Choice (45 CFR Part 54a)
Block Grant-funded faith-based organizations
cannot use these funds for inherently religious
activities such as the following:
Worship
Religious instruction
Proselytization
Organizations can engage in such religious
activities only if:
The activities are offered separately, in time or
location, from Block Grant-funded activities
Participation in the activities is voluntary
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Charitable Choice (45 CFR Part 54a)
In delivering services, including outreach activities,
SAMHSA-funded religious organizations cannot
discriminate against current or prospective program
participants based on:
 Religion
 Religious belief
 Refusal to hold a religious belief
 Refusal to actively participate in a religious practice
If an otherwise eligible client objects to the religious
character of a Block Grant-funded program, the
program shall refer the client to an alternative
provider within a reasonable period of time of the
objection.
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Charitable Choice (45 CFR Part 54a)
Similar to all other nongovernmental
organizations that receive Block Grant funds,
religious organizations must use generally
accepted auditing and accounting principles to
account for Block Grant funds.
Religious organizations shall segregate
Federal funds from non-Federal funds. Only
the Federal funds shall be subject to audit by
the government.
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Charitable Choice (45 CFR Part 54a)
State or local governments that contribute
funds to supplement Block Grant-funded
activities have the option of keeping the
State/local funds separate from the Block
Grant funds or commingling State/local funds
with Block Grant funds.
When a State or local government
commingles State/local funds with Block
Grant funds, the Charitable Choice
requirements will apply to all the commingled
funds.
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Thank you for your participation!
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment
www.samhsa.gov
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