Reporting Template for

Substance Abuse and Mental Health (SAMH)

Integrated Block Grant

Florida Department of Children and Families

Substance Abuse and Mental Health Services

Instructions

The Department of Children and Families’ Substance Abuse and Mental Health office requires the following report for statewide Block Grant reporting to the Substance Abuse and Mental Health Services Administration (SAMHSA).

Please submit a completed report to your Regional Contract Manager.


Insert Name of ME

Managing Entity (ME)

Semi-Annual Substance Abuse Prevention and Treatment

Block Grant (SAPTBG) and Community Mental Health Block Grant (CMHBG) Compliance Report

Year-End Report Report Period: July 1, 2013 through June 30, 2014

System Monitoring Performance Indicators (2014 Block Grant Annual Report Table 3)

Performance Indicator / Required Narrative Description
Describe routine monthly data collection processes within your network; continuous quality improvement activities, technical assistance
Compliance with System of Care Report: Managing Entity needs assessment; Performance Improvement activities; strategic plan
Describe analysis to improve care coordination and access to service
Describe efforts to build relationships with Federally Qualified Health Centers (FQHCs)
Describe child welfare activities related to data integration; child assessment, and technical assistance
Describe the use of information technology, within your network.
Describe activities to reintegrate individuals discharged from SMHTF; and community supports e.g. supportive housing
Discuss wraparound community services provided e.g. peer support
Describe your network activities to monitor treatment planning to ensure cultural competence and trauma assessments.
Describe your network process for the selection of EBP and diversion from criminal justice activities.
Describe your network methodology for monitoring wait list to ensure services are provided timely to priority populations

Complete for SAPT BG:

Activity / A.  Treatment / B.  Prevention / C.  Total
1.  Planning, coordination, needs assessment / $ / $ / $
2.  Quality Assurance
3.  Training (post employment)
4.  Education (pre-employment)
5.  Program Development
6.  Research and Evaluation
7.  Information Systems
8.  Total

(SAPT 10) This table is intended to capture the count of persons with both initial and subsequent admissions to an episode of care.

Level of Care / Number of Admissions / Number of Persons Served / Mean Cost of Services / Median Cost of Services / Standard Deviation of Cost
Detoxification
Hospital Inpatient
Free-Standing Residential
Rehabilitation/Residential
Hospital Inpatient
Short-term (up to 30 days)
Long-term (over 30 days)
Ambulatory (Outpatient)
Outpatient
Intensive Outpatient
Detoxification
Opioid Replacement Therapy
Opioid Replacement Therapy
ORT Outpatient

(CMH 5) Complete for CMH non-direct service activities

Service / Expenditures
Technical Assistance Activities
-  Description / $
Data Collection/Reporting
-  Description
Other activities
-  Description
Total

Comments:

Section I : Report of ME SAPTBG 20% Set-Aside Fund Expenditures and Recipients by CSAP Prevention Strategy for SA Primary Prevention Programs

The Managing Entity (ME) is required to ensure the expenditure of no less than its designated allocation amount of the SAPTBG 20% Prevention Set-Aside Funding that is detailed in the Schedule of Funds. This amount is detailed in the following OCAs - MSA25, MSC27, MSCPP, and MSC80 (see table below for descriptions) for the provision of substance abuse primary prevention services. The ME agrees to ensure the maintenance of adequate provider records, including consumer records with individual consumer prevention outcomes, programmatic data, and fiscal records to provide full details of such recipients, activities, and expenditures for SAPTBG monitoring, reporting, and audit purposes, in accordance with the requirements of the SAPTBG, as contained in 45 C.F.R., pt. 96. See definitions section for description of CSAP Prevention Strategies.

A. List Name of ME Staff, Position Title, and Phone No. Who is Responsible for SAPTBG Prevention Compliance, Monitoring, and Quality Mgt. (Information required)

Below is a table of the SAMH Budget Office expenditure OCAs for substance abuse – adult and children. Specific appropriation OCAs are included.

State Program Component (SPC) Grouping / Expenditure OCA / OCA Title /
Substance Abuse - Adult / MSA25 / Prevention Services
Substance Abuse - Children / MSC25 / Prevention Services
Substance Abuse - Adult / MSA70 / Adult Substance Abuse Projects
Substance Abuse - Children / MSC80 / Projects Informed Families of Florida
Substance Abuse - Children / MSCPP / Prevention Partnership Grant (PPG)

Report of Grant Expenditures to be Completed at Year-End for Period of July 1, 2013 – June 30, 2014: (Required)

(1a)
Information
Dissemination / (2a)
Education / (3a)
Alternatives
/ (4a)
Problem
Identification
and Referral / (5a)
Community-
Based Process / (6a)
Environmental / (7a)
Combined
Total $
Child SA / $ / $ / $ / $ / $ / $ / $
Adult SA / $ / $ / $ / $ / $ / $ / $
Total SA / $ / $ / $ / $ / $ / $ / $

B. List all other ME funds in SFY 2012-2013 for SA Primary Prevention by source (Federal/State). (Required)

(Information required)
$ / $ / $ / $ / $ / $ / $

§  SA PRIMARY PREVENTION RECIPIENTS TARGETED BY CHILD/ADULT PRIMARY HIGH RISK FACTOR:

Comprehensive primary prevention programs should give priority to target population sub-groups that are at risk of developing a pattern of substance abuse. Programs should include activities and services provided in a variety of settings, that address specific risk factors, and that may be broken down by age, race/ethnicity, gender, and other characteristics of the population being served. (Summary of Significant Federal Funding Requirements, SAMHSA, 45 CFR Part 96, March 31, 1993).

SABG Table 9 – Prevention Strategy Report

C. Recipient Groups Targeted to be Served

Check () recipient groups to be served in non-treatment services provided by ME or contract agency staff through Substance Abuse Primary Prevention Programs to individual and group recipients, by Recipient Age and Primary High Risk Factor.

Column A (Risks) / Column B (Strategies) / Column C (Providers)
Children of Substance Abusers [1]
Pregnant Women / Teens [2]
Drop-Outs [3]
Violent and Delinquent Behavior [4]
Mental Health Problems [5]
Economically Disadvantaged [6]
Physically Disabled [7]
Abuse Victims [8]
Already Using Substances [9]
Homeless and/or Runaway Youth [10]
Other, Specify [11]
CSAP PREVENTION: NUMBER OF PERSONS SERVED SA PREVENTION PROGRAMS

D. Annual Report of Persons Served: (All totals must equal)

Age / Total / Single Services / Recurring Services / Race, Ethnicity, and Gender / Total / Single Services / Recurring Services / *Note:
The same “Total” is repeated for description of the population served by:
o  Age
o  Race
o  Ethnicity
o  Gender
Single Services:
Single Services are those services that are provided to an individual in a single session such as a group presentation or community event.
Recurring Services:
Recurring Services are those services that are provided to an individual through a continuing multi-session event such as participation in an evidence-based curriculum.
0-4 / American Indian/Alaska Native
5-9 / Asian
10-11 / Black/African American
12 / Native Hawaiian/Other Pacific Islander
13 / White
14 / More than One Race
15 / Unknown
16 / Total*
17 / Not Hispanic or Latino
18-20 / Hispanic or Latino
21-24 / Total*
25-44 / Male
45-64 / Female
65+ / Total*
Total*

SAPTBG PRIMARY PREVENTION NUMBER OF CONSUMERS SERVED BY PROGRAM STRATEGY: See definitions of CSAP Prevention Strategies.

Number of Consumers:

Information
Dissemination / Education /
Alternatives
/ Problem
Identification
and Referral / Community-
Based Process / Environmental / Combined
Total / Expenditures
Child SA
Adult SA
Total SA

SABG Table 5a – Primary Prevention Expenditures Checklist

/ IOM Target / SAPT Block Grant / Other Federal / State / Local / Other /
1. Information Dissemination / Universal / $ / $ / $ / $ / $
Selected / $ / $ / $ / $ / $
Indicated / $ / $ / $ / $ / $
Unspecified / $ / $ / $ / $ / $
2. Education / Universal / $ / $ / $ / $ / $
Selected / $ / $ / $ / $ / $
Indicated / $ / $ / $ / $ / $
Unspecified / $ / $ / $ / $ / $
3. Alternatives / Universal / $ / $ / $ / $ / $
Selected / $ / $ / $ / $ / $
Indicated / $ / $ / $ / $ / $
Unspecified / $ / $ / $ / $ / $
4. Problem Identification and Referral / Universal / $ / $ / $ / $ / $
Selected / $ / $ / $ / $ / $
Indicated / $ / $ / $ / $ / $
Unspecified / $ / $ / $ / $ / $
5. Community-Based Services / Universal / $ / $ / $ / $ / $
Selected / $ / $ / $ / $ / $
Indicated / $ / $ / $ / $ / $
Unspecified / $ / $ / $ / $ / $
6. Environmental / Universal / $ / $ / $ / $ / $
Selected / $ / $ / $ / $ / $
Indicated / $ / $ / $ / $ / $
Unspecified / $ / $ / $ / $ / $
7. Section 1926-Tobacco / Universal / $ / $ / $ / $ / $
Selected / $ / $ / $ / $ / $
Indicated / $ / $ / $ / $ / $
Unspecified / $ / $ / $ / $ / $
8. Other / Universal / $ / $ / $ / $ / $
Selected / $ / $ / $ / $ / $
Indicated / $ / $ / $ / $ / $
Unspecified / $ / $ / $ / $ / $
Suicide Prevention / Universal / $ / $ / $ / $ / $
Selected / $ / $ / $ / $ / $
Indicated / $ / $ / $ / $ / $
Unspecified / $ / $ / $ / $ / $
Total / $ / $ / $ / $ / $

Section II: Managing Entity and Network Service Providers SAPTBG Primary Prevention Strategies and Activities Checklist

A. SA PRIMARY PREVENTION PROGRAM DEFINITION AND STRATEGIES FOR PURPOSES OF SA PREVENTION AND TREATMENT BLOCK GRANT

Substance Abuse Primary Prevention Programs are those directed at individuals who do not require treatment for substance abuse. Such programs are aimed at educating and counseling individuals on such substance abuse and providing for designated non-treatment activities to reduce the risk of abuse. Early intervention activities may not be counted towards the required 20% Primary Prevention Program Set-Aside in the new Block Grant regulations, nor may primary prevention services include any activity designed to determine if a person is in need of treatment. Check () all activities and methods supported for applicable SAPTBG expenditures.

6

Prepared By: SAMH Program Office

Last Update: April 11, 2014

(1) Information Dissemination: This strategy provides awareness and knowledge of the nature and extent of alcohol, tobacco, and drug use, abuse and addiction and their effects on individuals, families and communities. It also provides knowledge and awareness of available prevention programs and services. Information dissemination is characterized by one-way communication from the source to the audience, with limited contact between the two. Examples include:

Clearinghouse/information resource center(s); Resource directories;

Media campaigns; Brochures;

Radio/TV public service announcements; Speaking engagements;

Health fairs/other health promotion, e.g., conferences, meetings, seminars;

Information lines/Hot lines; and Other (Specify):______

(2) Education: This strategy involves two-way communication and is distinguished from the Information Dissemination strategy by the fact that interaction between the educator/facilitator and the participants is the basis of its activities. Activities under this strategy aim to affect critical life and social skills, including decision-making, refusal skills, critical analysis (e.g. of media messages) and systematic judgment abilities. Examples include:

Ongoing classroom and/or small group sessions (all ages);

Parenting and family management classes; Mentors;

Peer leader/helper programs;

Education programs for youth groups;

Children of substance abusers groups;

Preschool ATOD prevention programs; and

Other (Specify):______

(3) Alternatives: This strategy provides for the participation of the target populations in activities that exclude alcohol, tobacco, and other drug use. The assumption is that constructive and healthy activities offset the attraction to, or otherwise meet the needs usually filled by alcohol, tobacco and other drugs and would, therefore, minimize or obviate resort to the latter. Examples include:

Drug free dances and parties; Outward Bound;

Youth/adult leadership activities; Recreation activities;

Community drop-in centers;

Community service activities; and Other (Specify):______

(4) Problem Identification and Referral: This strategy aims at identification of those youth who have indulged in illegal/age-inappropriate use of tobacco or alcohol and those individuals who have indulged in the first use of illicit drugs in order to assess if their behavior can be reversed through education. It should be noted, however, that this strategy does not include any activity designed to determine if a person is in need of treatment. Examples include:

Marketing Only of Employee Assistance Programs; (SAMH policy prohibits the payment of federal or state funds through UCR or Non-UCR funding to support EA Programs)

Student assistance programs; Other (Specify):______

(5) Community-Based Process: This strategy aims to enhance the ability of the community to more effectively provide prevention and treatment services for alcohol, tobacco and other drug abuse disorders. Activities in this strategy include organizing, planning, enhancing efficiency and effectiveness of services implementation, inter-agency collaboration, coalition building and networking. Examples include:

Community and volunteer training, e.g., neighborhood action training,

Impacted training (key people in the system), staff/officials training;

Systematic planning; Community team-building;

Multi-agency coordination and collaboration/coalition;

Accessing services and funding; and Other (Specify):______

(6) Environmental: This strategy establishes or changes written and unwritten community standards, codes and attitudes, thereby influencing incidence and prevalence of alcohol, tobacco and other drugs used in the general population. This strategy is divided into two subcategories to permit distinction between activities which center on legal and regulatory initiatives and those that relate to service and action-oriented initiatives. Examples include: