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 7 and April 14, 2005
 
 

1. Can we use grant funds to pay the salary of the mental health commissioner or other current employee who will work full time on transformation?

The overall Terms and Conditions of all SAMHSA cooperative agreements state that “grant funds cannot be used to supplant current funding of existing activities.”  The salaries of State employees working on transformation could be covered by grant funds.  Salaries covered by the grant would free up State money that could then be used to hire others to cover the non-transformation duties of those employees.  If you plan to pay existing State employees out of grant funds, be sure to explain in your budget narrative how what you are doing is not supplanting “current funding of existing activities.”  You will also have to explain in your application, in “Section D:  Proposed Approach:  Sustainability,” how you will sustain your transformation activities after the grant funding has ended.

To view other standard Terms and Conditions of SAMHSA grant programs, go to www.samhsa.gov.  Click on “Grants.”  Click on “Grants Management at SAMHSA.”  We suggest that you review all the materials listed on this web page.

 

 

2.  Do all the members of the Transformation Working Group have to be from governmental organizations?

No.  The list of organizations in Appendix F includes representatives of philanthropies and the business community, insurance providers, clinical providers that are not funded by public funds, and others that are not governmental organizations.  Many of the Transformation Working Group members will be from governmental organizations, but you can have non-governmental people as well.  We hope that transformation will, among other things, help bring the privately-funded and the publicly-funded worlds together.
   
 

3.  Who will score my application?

Applications for all of SAMHSA’s grant programs are scored by independent peer reviewers.  Federal staff will instruct peer reviewers to refer to each of the bullets under the Evaluation Criteria in the RFA as they score the applications.  Be sure to respond to every single bullet under each of the evaluation criteria.
 
 

4.  How much of the Needs Assessment and Inventory of Resources do we need to include in the application?

Look at the bullets under Section A of the Evaluation Criteria, “Statement of Need.”  Be sure to respond to what is required there, and do as much as you think is reasonable to convince the reviewers that there is a need for improved infrastructure and that you have some good resources to build on.  Providing data with the application would probably be very useful.  Once you are awarded the grant, you would have time to complete the “thorough” needs and resources assessments. Some states may already have completed a comprehensive needs and/or resources assessment that they can draw on in crafting their Statement of Need.  They won’t have quite as much to do once the grant is awarded.
 
 

5.  Would you provide more detail on the seven GPRA measures listed on page 11?  For example, what kind of policy changes you all are looking for under the first item.

In creating these GPRA indicators, we went through the entire list of goals and recommendations of the New Freedom Commission Report, and came up with what we thought would be good indicators for each one of the goals and recommendations. Appendix C contains a short list of some of those indicators.  We indicated in parentheses after each indicator which of the seven primary GPRA measures it applies to.  For the policy indicators, you’d look for the items in Appendix C with a number one in parentheses afterwards.  The types of policy changes that you might be working towards include eliminating seclusion and restraint or creating a rural mental health policy that includes consumers in all aspects of care, etc, etc.  The policies included in Appendix C, and any you might develop, should specifically address the goals and recommendations of the New Freedom Commission Report.
 
 

6.  One allowable activity in the RFA is “data infrastructure/MIS development that complements but does not duplicate the activities of the SAMHSA/ CMHS Data Infrastructure Grant Program, that better meets the needs and preferences of mental health consumers and their families, and that allows for interagency exchange of information.”  We understand that we could not – and would not want to – duplicate the activities we’re already doing.  But if we wanted to elaborate and extend the consumer satisfaction measures we have developed with the data infrastructure grant, could we using the MHT SIG funds as some of the funding for that?

Yes.  The example you gave is a good one.  However, you would have to make  it clear how your activity supports the goals and recommendations of the New Freedom Commission Report and how you are complementing, not duplicating, the Data Infrastructure Grant Program.
 
 

7.  I am working on the consumer piece of the application.  Is there any specific goal we should start with, or should we look over all the goals and find places where consumers can contribute?

The expectation of the RFA is that the applicant will address all the goals in the President’s New Freedom Commission Report.  You may emphasize any of them, but you must address all of them and justify whatever your emphasis is. Goal two addresses consumer and family issues most directly, but involvement of consumers and family members is really an underlying principle, a value that should serve as the foundation and the driving force of everything that you do. 

When you look at each of the goals of the New Freedom Commission Report, you can no doubt think of specific contributions consumers and family members can make to the accomplishment of each of those goals. 

As you know, consumers and family members are referred to throughout the RFA.  For example, the RFA requires that consumers and family members be actively involved in the Transformation Working Group, in the development of the application, and certainly later in the development of the comprehensive mental health plan.  Another requirement is the individual plan of care.  And one of the seven GPRA indicators is to increase the number of consumers and family members that are members at statewide consumer and family run networks. 

When you write your applications, be sure to describe how you will address issues related to parents or other caretakers of children who have a serious emotional disturbance.  And, consumers also include youth consumers, so also address how you will involve youth in a meaningful way.
 
 

8.  In our state, there is a real push to consider competitive procurement of our contract providers. So in our application, is it better to name a specific evaluator or to indicate that we would bid it out competitively?

It would be better if you can identify a specific individual.  The Evaluation Criteria in Section F:  Evaluation and Data (p. 32) asks you to identify the personnel who will be responsible for GPRA and evaluation activities, describe their qualifications, include their biographical sketch, and include their letter of commitment.  To make your application the most competitive, you would want somebody already identified. 

If you really can’t do that, include a very clear job description, and describe exactly how you are going to get a high quality person.  The evaluator should be helping prepare the application, especially the section on evaluation and data.  You want to have as many specifics and details about what the evaluation design is going to be and what instruments will be used, what consent forms, if any, are necessary, what kind of analysis, how the analysis of data will be fed back to continuously improve the project, etc.  So try to get an evaluator upfront who can help write this piece of the application.

One other piece of advice – Be sure to consider your contracting process when you develop your timeline for the grant activities.  Many times, grantees fall behind because they underestimate the length of time the contracting process will take. 

 
 

9.  Under Section I - Biographical Sketches and Job Descriptions on p. 16 of the RFA, we’re instructed to “include biographical sketches and job descriptions for the Transformation Working Group Chairperson and up to 10 other key positions.” Does this include members of the Transformation Working Group?

No.  You should include in Section I people like the Chairperson’s full time assistant and other key people who will be on the transformation staff, regardless of what department they’re in.  For example, who will be the key person from, say, the Child Welfare Department, who will handle day to day transformation tasks?  There is essentially a 22 page limit on what you can include here.

Think carefully about who the key personnel of the grant should be.  Once the grant is awarded, key personnel can only be changed with the prior approval of SAMHSA.  Key personnel are typically paid out of the grant and hold primary responsibility for ensuring that the goals and activities of the grant are completed as stated in the application.  You should include, for example, the Evaluator(s) as key personnel, as well as other staff (including consumers and family members) with major roles on the grant.

You will identify the specific members of the Transformation Working Group, the role of each, their level of effort and qualifications, and evidence of their commitment to transformation in your narrative.  See “Section E:  Staff, Management, and Relevant Experience,” bullet, 2, p. 31.  Additional biosketches for individuals on the Transformation Working Group, therefore, are not necessary in Section I.

 
 

10.  The RFA says the MHT SIG must link to other appropriate grant programs in the state.  Does this mean Federal grant activities of other agencies in addition to SAMHSA?

We want you to leverage all the different federal, state, tribal, foundation, and any other grant monies you possibly can in a way that creates a comprehensive approach.  Talk with people who have a budgetary overview of the state, find out where different funds come from, and identify how these disparate projects can be coordinated so they contribute to a comprehensive plan. 

For your inventory of resources, you will look at personnel, grants, etc. of each of the different organizations on your Transformation Working Group.  For example, your Department of Education probably knows of some Safe Schools/Healthy Students’ grants.  Another member may look at prevention, juvenile justice, or criminal justice resources.  As you develop your inventory, you may be surprised by how many resources you have to build on. 

Federal agencies are beginning to reference each others’ relevant grant programs.  For example, the MHT SIG program is referenced in the Department of Education’s new program, Grants for the Integration of Schools and MH Services:  http://e-grants.ed.gov. 
 
 

11.  Recommendation 6.2 is to “develop and implement integrated electronic health record and personal health information systems.”  Do you see HIPAA as posing any obstacles to establishing an integrated electronic health record?

You certainly have to consider the HIPAA rules in developing these systems.  For your application identify people involved in making sure your activities are HIPAA compliant. Go to www.mhsip.org/ds2000/newindex.htm. Crosswalks between HIPAA transaction-related dataset data fields and others associated with a proposed set of data for a personal record are provided there.  For more information on HIPAA, see http://hipaa.samhsa.gov/hipaa.html.
 
 

12.   On page 29, bullet #2, the RFA says, “include information about the prevalence of mental illness in the State, etc, and related risk and protective factors.”  What do you mean by this?

The issues of prevalence, incidence, and risk and protective factors are central to the public health approach.  Risk factors are things that increase the likelihood of an unsuccessful outcome, whereas protective factors increase the likelihood of a successful outcome. A 1994 IOM report, Reducing Risks for Mental Disorders (http://www.nap.edu/catalog/2139.html) states “prevention of the initial onset of mental disorders can be accomplished through intervention programs aimed at risk reduction, which can include both reduction of causal risk factors and enhancement of protective factors” (Mrazek & Haggerty, 1994, p. 215).  The report includes risk factors associated with depression and schizophrenia, as well as risk factors common in many mental disorders.
 
 

13.  States have a stream of funding from the Community Mental Health Services Block Grant to help stabilize the MHT SIG activities after the end of the five year grant. Since tribes are not eligible for the Block Grant, is there a similar SAMHSA funding stream for tribes? If not, this seems to give states an unfair advantage in leveraging additional funds in Section D: Proposed Approach: Sustainability (10 points) of the actual application.

We will instruct reviewers to focus on how well an applicant plans to use whatever resources are available rather than only on the amount of resources available.
 
 

14.  What tribes and states have been funded under this grant program in the past?

None.  This is the first time this program has ever been offered.
 
 

15.  Is this a one-time announcement, or will the program be offered again next year?

The program is in the President’s FY-2006 budget,  However, we cannot be sure of the funding for next year until the FY-2006 budget is passed by Congress and signed by the President.  Since we cannot guarantee that a second round of grants will be funded, we encourage you to apply for the current round.
 
 

16.  Do you have any advice about submitting our applications electronically?

We encourage electronic applications.  However, you should start getting your pass code and learning the system well in advance of the June 1 due date for the applications.  This is a fairly new system, and it may take a little experimenting to understand how it works.
 
 

17.   Is it acceptable for the governor to delegate to his mental health commissioner the authority to appoint the members of the transformation work group? 

No.  The mental health commissioner is in a great position to provide suggestions and help identify people for the team, but ultimately the governor must appoint them. 

 
 

18.   In tribes and tribal organizations, how do we differentiate between our chief executive and our chairperson of the transformation working group? 

This is confusing because sometime the chief executive or a tribe is referred to as the “chairperson.”  In the RFA, we use the term “chief executive officer” to refer to the tribal government leader.  He/she would then appoint the chairperson of the transformation working group to be the overall transformation project leader. Similarly, the chief executive officer of a tribal organization would appoint the chairperson of that tribal organization’s transformation working group.
 
 

19.   Is it permissible to have a multi-level transformation organization?

The scope of project is going to require a multi-level government structure.  You have the Governor’s Transformation Working Group composed of Cabinet-level and other very senior people.  Then you will probably have a lower level group, which you might call the “Implementation Group,” that would be responsible for much of the day-to-day transformation activities.  Just be sure to call the higher level group the “Transformation Working Group” since this is how the RFA refers to it.
 
 

20.  Some of the people we want to include on our Implementation Group are currently employed somewhere in the state.  When we re-deploy them to work on this grant full-time, other staff will pick up their current responsibilities.  Is that considered supplanting, or can we, in fact, pay for persons that are already employees of the state with funds from this grant? 

It is clearly permissible for a current state employee to move into a full-time transformation position and to be paid out of the MHT SIG grant funds.  In your application, be clear about how this person’s current salary will be used, and demonstrate that you are not supplanting any funds.  You could discuss this issue in two places:  (1) in your budget narrative, and (2) in your section on sustainability.  For the latter, be sure to show that you have a plan for maintaining this level of activity across and after the lifespan of the grant. 

 
 

21.  For the leader of the Transformation Working Group, we’re looking for a very highly qualified person, somebody who may be a public figure, and somebody who is willing to commit to taking the job in October if we get this grant.  He/she would have to put his or her career on hold until we find out whether or not we’re going to be funded.  Is this the situation as you understand it? 

In your grant application, you must identify your chairperson and include his/her resume because the grant review committee needs that to evaluate how strong the leader will be. We understand that people may not want their constituencies or their current employer to know that they are signing on to the MHT SIG project.  However, when people are asked to step up by the governor or tribal chief, they certainly may be willing to do it, particularly if they knew that their names are not going to be in the media, at least until an award was made. 

 
 

22.  People are going to want to see copies of our application.  It sounds as if we’re either not going to be able to provide them, or we’re going to have to black out all the information on our leader. 

All applications for SAMHSA grant programs are kept confidential throughout the review process. Information is released to the public only if an award is given.  If we do not give an award to an applicant, we are not allowed to release any information from the application.  Confidentiality is built into the process.  Each applicant can decide whether he/she wants to release any part of his/her application, but SAMHSA will not do so unless and until it awards a grant.
 
 

23.  The program the chairperson of our transformation working group is currently working on will be a major component of our transformation activities.  How in-depth do we have to be about who will handle his non-transformation related responsibilities during the five years of the grant program?

Describe the strategy you will use to address this issue and make it clear that you are not supplanting funds.  In addition, describe whatever responsibilities the chairperson now has that the new person is going to cover. 

   
   

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File Date: 9/24/2008