Matrix: Mental Health System Transformation

Developing Infrastructure to Improve Availability and
Effectiveness of Mental Health Services

Mental Health Transformation State Incentive Grant Program

Pre-Application Technical Assistance

Questions and Answers from Conference Calls, April 28, 2005

1. Are we required to submit a line item budget for each year of the five years of the grant?

Yes, you are required to include a line-item budget for all five years in the application. We understand that the budgets will be estimates and projections. Each year, grantees are required to submit a continuation application in which they propose a revised, more specific budget that becomes the actual budget for the coming year.

2. Is a Cost of Living Allowance (COLA) allowable in budgets for years 2-5?

A COLA can be built into future year budgets using grant funds, as long as the increase does not result in a budget that exceeds the limits of the award amount.  You would have to decrease some budget item(s) in order to have funds for the COLAs if you took them out of grant funds. If you have funds from other sources, you could use those for COLAs. 

3. Is there a cap on COLAs for each year?

There is no cap. However, the increase must be reasonable, and the organization needs to make sure that it does not establish a separate policy regarding salary increases for the staff working on this grant project.  The COLA must be based on an organizational written policy already in place for all personnel. 

4. Can grant funds be used for Consumer Satisfaction Teams as in the Philadelphia Model?

Yes. The “Philadelphia Model” refers to Consumer Satisfaction Teams that meet with consumers and/or family members in community mental health programs at least once a year. The teams are staffed by trained and paid consumers and family members who interview people according to a protocol. They create reports on issues related to consumer satisfaction with services for program and agency administrators as well as policy makers in local and state offices of behavioral health. It creates a feedback loop so that planners and policy makers can better understand and respond to consumer and family member’s needs and wishes.

5. What types of data collection instruments and interview protocols should we include in Appendix 2?

Include any instruments or measures that you already have to track elements of your program over time. For example, if you wanted to track consumer satisfaction, you might use the instruments included in SAMHSA/CMHS’ Decision Support 2000+. Go to www.ds2kplus.org, and select the MHSIP Survey option from the row of choices near the top of the screen. This will take you to a choice of consumer satisfaction instruments -- one for adults, one for youths, and one for family of young consumers. You may already be using this if you report data through the Uniform Reporting System (URS).

Since this is an infrastructure grant program, you will need to develop infrastructure measures as you develop your comprehensive mental health plan. Provide in the application what you think those measure might be. Appendix C of the RFA might be helpful in thinking about this.

Interview protocols would include items such as the one used by the Consumer Satisfaction Teams described in #3.

6. The RFA (p. 12) states that, by the end of the first year of the grant, grantees will identify from their comprehensive mental health plans the changes they expect to make that will eventually count towards GPRA results. Is it realistic to expect that a grantee can complete the needs assessment, the inventory of resources, and the comprehensive plan all in the first year?

Since grantees’ needs assessment and resources inventory will be well underway by the time they submit their applications, we believe they will be able to revise them, get them approved, develop the comprehensive plan, and get it approved within the first year. CMHS understands that the GPOs will have to provide a quick turnaround of any documents grantees submit. For the timeline you have to submit with the application, include all of these tasks in the first year.

7. Some transformation activities have already been implemented in our state that we plan to fold into our comprehensive plan. Are we supposed to put these on hold until we develop our plan and get it approved?

No. You do not need to put on hold the transformation activities you are already doing. You could include these in your inventory of resources – activities you plan to build on.

8. What are some examples of tele-health activities?

A number of states already offer tele-health activities in rural areas where there are few physicians. A physician or other mental health provider might use interactive TV to help clinicians make diagnoses or follow-up some cases. Sometimes clinicians use this kind of technology to interact directly with consumers. Another example is a web-based training program for staff.

9.We’re collecting a great deal of information for our preliminary inventory of resources. We will summarize them in a table, but should we include the full inventory in an appendix?

You are restricted to the table, and some applicants have to be very selective because you don’t want to take up too much of your narrative section with the table. You might want to say that, because of space constraints, you are able to include only a portion of the resources you have available and that you will gladly supply the rest upon request.

10. Do you want a listing of the programs, policies, and equipment in the table?

Yes. You might include state-level programs such as a state-wide mental health in schools program. If your state has them, you might include some major SAMHSA grants (e.g., Safe Schools/Healthy Students, the Child and Adolescent State Infrastructure Program, the Strategic Prevention Framework State Incentive Grant, etc.), as well as grants from other agencies.

Examples of policies might be California’s Mental Health Services Act or Illinois’ Children’s Mental Health Services Act. (Other examples may be found at www.nasmhpd.org.)

Regarding equipment, you don’t need to include every computer in every organization on your transformation working group. However, you should provide evidence of adequate computer technology for collecting data and coordinating services. Include whatever equipment you have that will help you manage your activities and enable you to work across agencies, to make sure that there’s appropriate housing, employment, transportation, and so on. Another example of equipment might be tele-health equipment.

11. One requirement in Section F: Evaluation and Data is to “describe how existing resources and approaches will be modified or enhanced to collect and report data for your GPRA measures and your evaluation of mental health transformation.” Should we describe how all of our existing resources and approaches will be modified or enhanced, or is this just specific to the Data Infrastructure Grant?

It is not just specific to the Data Infrastructure Grant (DIG). It includes the DIG, plus any other evaluation and data resources you have.

12. Will you clarify what is meant when the RFA says, “Describe the process by which the state will ensure that providers develop, in full partnership with consumers and family members, individualized plans of care, that will improve service coordination, help people to make informed choices, and ultimately achieve and sustain recovery?”

Describe what you will do to involve consumers, family members, providers, and other relevant people from the agencies on your transformation working group in developing and implementing an individualized plan(s) of care. Such a group might develop a template for an individualized plan, develop and implement training programs for providers, consumers, and others on how to use the plan(s), develop a policy by which the state would require providers to develop such plans of care with each consumer and/or family, and similar activities.

Representatives from different agencies on the transformation working group should be involved to ensure that the plan will “improve service coordination” for consumers and families. We do not want the consumer to have plans in three or four different systems that don’t connect with each other. The plan would affect the infrastructure, especially the information technology, of all organizations involved.

13. Aren’t there confidentiality issues involved in including family members in the development of a person’s individualized plan?

It depends. Some adult consumers may not want their family members involved, and unless there is a compelling reason to do so (e.g., safety of self or others), the provider cannot break consumer confidentiality and involve the family members. However, some adults do want family members involved, and with his/her permission, you can involve whoever he/she wants.

If a child or adolescent is the consumer, then it is essential that family members or other caring adults are involved, within the parameters of the specific state laws.

14. Our agency has a DUNS number, and we have received a number of SAMHSA grants. Do we still need to go through other registration processes to submit our application electronically?

Yes. That is why we urge you to start these processes as soon as possible.

15. The agencies on the transformation working group will be signing MOUs to demonstrate their commitment to the transformation process and activities. Would consumers and family members on the group also sign MOUs, or are consent forms needed?

No. The consumers and family members would not have to sign an MOU, and a consent form is not needed in this case. However, it probably would be good to have a letter of commitment from consumers and family members on your transformation working group to demonstrate that they are as much a part of the group as any other member and also because they can speak quite eloquently about the importance of transforming the mental health and related systems.