Department of Health and Human Services

Substance Abuse and Mental Health Services Administration

Treatment for Individuals with Serious Mental Illness, Serious Emotional Disturbance,or Co-Occurring Disorders Experiencing Homelessness

(Short Title: Treatment for Individuals Experiencing Homelessness)

(Initial Announcement)

Funding Opportunity Announcement(FOA) No. SM-18-014

Catalogue of Federal Domestic Assistance (CFDA) No.: 93.243

Key Dates:

Application Deadline / Applications are due by March 9, 2018.
Intergovernmental Review
(E.O. 12372) / Applicants must comply with E.O. 12372 if their state(s) participate(s). Review process recommendations from the State Single Point of Contact (SPOC) are due no later than 60 days after application deadline.
Public Health System Impact Statement (PHSIS)/Single State Agency Coordination / Applicants must send the PHSIS to appropriate state and local health agencies by the administrative deadline. Comments from the Single State Agency are due no later than 60 days after the application deadline.

Table of Contents

EXECUTIVE SUMMARY

I.PROGRAM DESCRIPTION

1.PURPOSE

2.EXPECTATIONS

II.FEDERAL AWARD INFORMATION

III.ELIGIBILITY INFORMATION

1.ELIGIBLE APPLICANTS

2.COST SHARING and MATCHING REQUIREMENTS

3.EVIDENCE OF EXPERIENCE AND CREDENTIALS

IV.APPLICATION AND SUBMISSION INFORMATION

1.REQUIRED APPLICATION COMPONENTS:

2.APPLICATION SUBMISSION REQUIREMENTS

3.FUNDING LIMITATIONS/RESTRICTIONS

4.INTERGOVERNMENTAL REVIEW (E.O. 12372) REQUIREMENTS

V.APPLICATION REVIEW INFORMATION

1.EVALUATION CRITERIA

2.REVIEW AND SELECTION PROCESS

VI.FEDERAL AWARD ADMINISTRATION INFORMATION

1.REPORTING REQUIREMENTS

2.FEDERAL AWARD NOTICES

VII.AGENCY CONTACTS

Appendix A – Application and Submission Requirements

1.GET REGISTERED

2.APPLICATION COMPONENTS

3.WRITE AND COMPLETE APPLICATION

4.SUBMIT APPLICATION

5.AFTER SUBMISSION

Appendix B - Formatting Requirements and System Validation

1.SAMHSA FORMATTING REQUIREMENTS

2.GRANTS.GOV FORMATTING AND VALIDATION REQUIREMENTS

3.eRA COMMONS FORMATTING AND VALIDATION REQUIREMENTS

Appendix C – Statement of Assurance

Appendix D – Confidentiality and SAMHSA Participant Protection/Human Subjects Guidelines

Appendix E – Developing Goals and Measureable Objectives

Appendix F – Developing the Plan for Data Collection, Performance Assessment, and Quality Improvement

Appendix G – Biographical Sketches and Position Descriptions

Appendix H – Addressing Behavioral Health Disparities

Appendix I – Standard Funding Restrictions

Appendix J – Intergovernmental Review (E.O. 12372) Requirements

Appendix K – Administrative and National Policy Requirements

Appendix L – Sample Budget and Justification (no match required)

EXECUTIVE SUMMARY

The Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Mental Health Services (CMHS),isaccepting applications for fiscal year (FY) 2018 –Treatment for Individuals with Serious Mental Illness, Serious Emotional Disturbance or Co-Occurring Disorders Experiencing Homelessness (Short Title: Treatment for Individuals Experiencing Homelessness). The purpose of this programis tosupport the development and/or expansion of the local implementation of an infrastructure that integrates behavioral health treatment and recovery support services for individuals, youth, and families with a serious mental illness, serious emotional disturbance,or co-occurring disorder (i.e., a serious mental illness [SMI] and substance use disorder [SUD] or a serious emotional disturbance [SED] and SUDwho are experiencing homelessness.)

Funding Opportunity Title: / Treatment for Individualswith Serious Mental Illness, Serious Emotional Disturbance or Co-occurring Disorders Experiencing Homelessness (Short Title: Treatment for Individuals Experiencing Homelessness)
Funding Opportunity Number: / SM-18-014
Due Date for Applications: / March 9, 2018
Anticipated Total Available Funding: / $10,393,000
Estimated Number of Awards: / Up to 16
Estimated Award Amount: / Up to $1 million per year for state governments and territories.
Up to $500,000 per year for governmental units within political subdivisions of a state, such as a county, city or town; federally recognized American Indian/Alaska Native (AI/AN) tribes, tribal organizations, Urban Indian Organizations, and consortia of tribes or tribal organizations; public or private universities and colleges; and community- and faith-based organizations.
Cost Sharing/Match Required: / No
Anticipated Project Start Date: / September 30, 2018
Length of Project Period: / Up to five years
Eligible Applicants: / Eligible applicants are domestic public and private nonprofit entities:
  • State governments and territories, including the District of Columbia, Guam, the Commonwealth of Puerto Rico, the Northern Mariana Islands, the Virgin Islands, American Samoa, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau
  • Governmental units within political subdivisions of a state, such as a county, city or town
  • Federally recognized American Indian/Alaska Native (AI/AN) tribes, tribal organizations, Urban Indian Organizations, and consortia of tribes or tribal organizations
  • Public or private universities and colleges
  • Community- and faith-based organizations
[See Section III-1 for complete eligibility information.]

Be sure to check the SAMHSA website periodically for any updates on this program.

I.PROGRAM DESCRIPTION

1.PURPOSE

The Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Mental Health Services (CMHS),isaccepting applications for fiscal year (FY) 2018 –Treatment for Individuals with Serious Mental Illness, Serious Emotional Disturbance or Co-Occurring Disorders Experiencing Homelessness (Short Title: Treatment for Individuals Experiencing Homelessness). The purpose of this programis tosupport the development and/or expansion of the local implementation of an infrastructure that integrates behavioral health treatment and recovery support services for individuals, youth, and families with aserious mental illness, serious emotional disturbance or co-occurring disorder (i.e., a serious mental illness [SMI] and substance use disorder [SUD] or a serious emotional disturbance [SED] and SUD who are experiencing homelessness.

The goal of this program is toincrease capacity and provide accessible, effective, comprehensive, coordinated, integrated, and evidence-based treatment services, peer support and other recovery support services, and linkages to sustainable permanent housing. To achieve this goal, SAMHSA will support three types of activities: (1) integrated behavioral health treatment and other recovery-oriented services; (2) efforts to engage and connect clients to enrollment resources for health insurance, Medicaid, and mainstream benefits (e.g. Supplemental Security Income (SSI)/Social Security Disability Insurance (SSDI), Temporary Assistance for Needy Families (TANF), Supplemental Nutrition Assistance Program (SNAP), etc.); and (3) coordination of housing and services that support sustainable permanent housing.

Treatment for Individuals Experiencing Homelessnessgrants are authorized underthe Public Health Services Act, Section 520A, 42 U.S.C 290bb-32, as amended.

Definitions

States and territories are hereafter referred to as states.

Other domestic public and private nonprofit entities refers to governmental units within political subdivisions of a state, such as a county, city or town; federally recognized American Indian/Alaska Native (AI/AN) tribes, tribal organizations, Urban Indian Organizations, and consortia of tribes or tribal organizations; public or private universities and colleges; and community- and faith-based. These are hereafter referred to as “communities”.

The term co-occurring disorder (COD) hereafter refers to the presence of a SMI and SUD or a SED and SUD. In Section A of your Project Narrative,applicants are required to provide the state-approved definition for COD.

For the purposes of this FOA, SAMHSA has clarified the definitions of SMI and SED. SED refers to persons from birth to age 18 and SMI refers to persons age 18 and older who meet the following criteria:

  • At any time during past year has met the criteria for a mental disorder, including within developmental and cultural contexts, as specified within a recognized diagnostic classification system (e.g., DSM-V); and
  • Displays a functional impairment, as determined by a standardized measure, which impedes progress towards recovery and substantially interferes with or limits the person’s role or functioning in family, school, employment, relationships, or community activities.

Homeless, as characterized under the Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act of 2009, and defined by the December 5, 2011, Final Rule Defining Homeless (76 FR 75994), establishes four categories of homelessness. These categories are:

  • Individuals and families who lack a fixed, regular, and adequate nighttime residence and includes a subset for an individual who is exiting an institution where he or she resided for 90 days or less and who resided in an emergency shelter or a place not meant for human habitation immediately before entering that institution;
  • Individuals and families who will imminently lose their primary nighttime residence;
  • Unaccompanied youth and families with children and youth who are defined as homeless under other federal statutes who do not otherwise qualify as homeless under this definition; or
  • Individuals and families who are fleeing, or are attempting to flee, domestic violence, dating violence, sexual assault, stalking, or other dangerous or life-threatening conditions that relate to violence against the individual or a family member.

For the purposes of this FOA, the term homeless also includes “doubled-up” – a residential status that places individuals at imminent risk for becoming homeless. This is defined as sharing another person’s dwelling on a temporary basis where continued tenancy is contingent upon the hospitality of the primary leaseholder or owner and can be rescinded at any time without notice.

2.EXPECTATIONS

Treatment for Individuals Experiencing Homelessnessis one of SAMHSA’s services grant programs. SAMHSA intends that its services programs result in the delivery of services as soon as possible after award. At the latest, recipients are expected to provide services to the population(s) of focusno later than the fourth month after award.

Key Personnel:

Key personnel are staff members who must be part of the project regardless of whether or not they receive a salary or compensation from the project. These staff members must make a substantial contribution to the execution of the project

The key personnel for this program will be the Project DirectorandProject Evaluator. These positions require prior approval by SAMHSA after a review of job descriptions and staff credentials.

Required Activities:

These are the activities that everygrant project mustimplement. Required activities must be reflected in the Project Narrative in Section V.

You must use SAMHSA’s services grant funds primarily to support direct services, including the following required activities:

  • Provide outreach and other engagement strategies (utilizing screening and assessmenttools) to identify individuals (including youth) and families to enroll in the grant project. For individuals and families not eligible for enrollment, provide appropriate referrals for services and housing. For enrolled individuals and families, use screening and assessment results to develop appropriate treatment approaches. If applicable, identify strategies that engage youth and families in recovery efforts, including those focusing on Lesbian, Gay, Bisexual, Transgender, Questioning (LGBTQ) youth experiencing homelessness and youth experiencing early on-set of CODs.
  • Assist with identifying sustainable permanent housing. At a minimum, those enrolled individuals must be linked to HUD’s Coordinated Entry system.
  • Provide evidence-based, integrated mental health and substance use interventions for COD treatment for enrolled individuals. Treatment must be provided in outpatient, intensive outpatient, short-term residential, or recovery housing programs. Short-term residential programs must be for 30 days or less in duration and at a cost of no more than 5 percent of the total annual award.
  • Use an integrated primary/substance use disorder/mental health care approach in developing the service delivery plan.[1] This approach involves screening for health issues and delivery of client-centered substance use and mental health services in collaboration and consultation with medical care providers. Special attention should be paid to low-income and underserved populations.
  • Provide case management or other strategies to address serious mental illness, serious emotional disturbance,and co-occurring health conditions and link with and retain individuals in housing and other necessary services.
  • Engage and enroll the population(s) of focus in health insurance, Medicaid, and other benefit programs (e.g.SSI/SSDI, TANF, SNAP).
  • Provide trauma-informed services to include an emphasis on implementation of trauma-informed approaches in programs, services, and systems, including trauma-specific interventions designed to address the consequences of trauma in the individual and to facilitate healing. This may include assessment and interventions for emotional, sexual, and physical abuse.
  • If the population of focus are youth and families, provide services that are delivered within a family-driven, youth-guided/directed framework. Engagement of family and youth is integral to their treatment services and supports.
  • Collaborate across agencies (e.g., substance use, child welfare, juvenile justice, primary care, education, early childhood) and among crucialproviders and programs to enhance service provision. Collaboration between child and adult serving agencies is paramountwhen serving youth transitioning to adulthood.
  • Provideor assure linkage to and support engagement withrecovery support services to improve access to and retention in services and to continue treatment gains. This may include some or all of the following as appropriate for eachenrolled individual:
  • Vocational, child care, educational, and transportation services;
  • Independent living skills (e.g., budgeting and financial education);
  • Employment readiness, training and placement;
  • Crisis care;
  • Medication management;
  • Peer-related supports and services (e.g., peer-led or peer-supported activities andhiring of peer staff);
  • Discharge planning; and
  • Psychosocial rehabilitation services.

Allowable Activities:

  • Up to $25,000 per year may be used to purchase technical assistance (TA). If TA is not needed, recipients may use these funds for other required or allowable activities in the grant.
  • Limited screening to identify incarcerated individuals, consistent with the population(s) of focus,while incarcerated or upon release from a jail or detention facility, and provision to those identified with a post-release housing and behavioral health services plan.
  • Develop and implement tobacco cessation programs, activities and/or strategies.
  • Education, screening, and counseling for hepatitis and other sexually transmitted infections. Active steps to reduce HIV/AIDS risky behaviors by clients, including client screening, assessment, and either direct provision of appropriate services or referral to and close coordination with other providers of appropriate services.

Other Expectations:

If your application is funded, you will be expected to develop a behavioral health disparities impact statement no later than 60 days after your award. SeeAppendix H, Addressing Behavioral Health Disparities.

Although people with behavioral health conditions represent about 25 percent of the U.S. adult population, these individuals account for nearly 40 percent[2] of all cigarettes smoked and can experience serious health consequences[3]. A growing body of research shows that quitting smoking can improve mental health and addiction recovery outcomes. Research shows that many smokers with behavioral health conditions want to quit, can quit, and benefit from proven smoking cessation treatments. SAMHSA strongly encourages all recipients to adopt a tobacco-free facility/grounds policy and to promote abstinence from all tobacco products (except in regard to accepted tribal traditions and practices).

Recipients 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 not covered by 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 individual’s health insurance plan. Recipients are also expected to facilitate the health insurance application and enrollment process for eligible uninsured clients. Recipients should also consider other systems from which a potential service recipient may be eligible for services (for example, the Veterans Health Administration or senior services), if appropriate for and desired by that individual to meet his/her needs. In addition, recipients are required to implement policies and procedures that ensure other sources of funding are utilized first when available for that individual.

SAMHSA encourages all recipients to address the behavioral health needs of returning veterans and their families in designing and developing their programs and to consider prioritizing this population for services, where appropriate. SAMHSA will encourage its recipients to utilize and provide technical assistance for service members, veterans and their families. This includes efforts to engage their staff in cultural competency training courses and to collaborate with key organizations in their local communities that are focused on serving this population.

2.1Using Evidence-based Practices (EBPs)

SAMHSA’s 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 EBP refers to approaches to prevention or treatment that are validated by some form of documented research evidence. Both researchers and practitioners recognize that EBPs are essential to improving the effectiveness of treatment and prevention services in the behavioral health field.

While SAMHSA realizes that EBPs have not been developed for all populations and/or service settings, application reviewers will closely examine proposed interventions for their evidence base and appropriateness for the population to be served. If an EBP(s) exists for the types of problems or disorders being addressed, the expectation is that EBP(s) will be utilized.

In Section Cof your Project Narrative, you will need to identify the EBP(s) you propose to implement for the specific population(s) of focus. In addition, you must discuss the population(s) for which the practice(s) has (have) been shown to be effective and show that it is (they are) appropriate for your population(s) of focus.

The following are examples of EBP(s)that exist/apply for your program/population(s) of focus:

  • Housing First models.
  • Integrated Dual Disorders Treatment.
  • Assertive Community Treatment.

Combined treatment and programmatic elements are suggested for serving COD populations. Examples of treatment level interventions include Psychopharmacological, Motivational, and Behavioral Interventions.