Description
The Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment (CSAT) and the Center for Mental Health Services (CMHS) are accepting applications for fiscal year (FY) 2011 for Cooperative Agreements to Benefit Homeless Individuals (CABHI). The purpose of this program is to support the development and/or expansion of local implementation and community infrastructures that integrate treatment and services for mental and substance use disorders, permanent housing, and other critical services for individuals who are chronically homeless. SAMHSA seeks to increase the number of individuals who are chronically homeless placed in permanent housing that supports recovery through comprehensive treatment and recovery services for behavioral health. SAMHSA also seeks to increase capacity for community-based providers to enroll individuals who are chronically homeless in mainstream programs and obtain reimbursement for behavioral health.This grant program builds on the success of the previous SAMHSA Services in Supportive Housing (SSH) program and SAMHSA Grants to Benefit Homeless Individuals (GBHI) program. Both SAMHSA SSH and GBHI programs combined housing assistance with intensive individualized support services to individuals who are chronically homeless. The Cooperative Agreements to Benefit Homeless Individuals program supports the development and/or expansion of local implementation and community infrastructures that integrate treatment and services for mental and substance use disorders, permanent housing, and other critical services for individuals who are chronically homeless through Medicaid and other mainstream programs. The major goal of the Cooperative Agreements to Benefit Homeless Individuals program is to ensure that the most vulnerable individuals who are chronically homeless receive access to sustainable permanent housing, treatment, and recovery supports through mainstream funding sources. To achieve this goal, SAMHSA funds will support three primary types of activities: 1) behavioral health, housing support, and other recovery-oriented services not covered under a State's Medicaid plan; 2) coordination of housing and services for chronically homeless individuals and families at the State and local level which support the implementation and/or enhance the long-term sustainability of integrated community systems that provide permanent housing and supportive services; and 3) efforts to engage and enroll eligible persons who are chronically homeless in Medicaid and other mainstream benefit programs (e.g., SSI/SSDI, TANF, SNAP).On a single night in January 2009, there were an estimated 643,067 sheltered and unsheltered people who are homeless nationwide. Of those, approximately 111,000 were chronically homeless. SAMHSA supports and has partnered to accomplish one of the U.S. Department of Housing and Urban Development's (HUD) policy priorities which has been the development of permanent housing programs that provide a combination of housing and supportive services to people who were formerly homeless and with disabilities. This announcement is aligned with both HUD and the U. S. Interagency Council on Homelessness Opening Doors: Federal Strategic Plan to Prevent and End Homelessness. Persons experiencing homelessness have higher rates of substance use and problems with mental health, physical health, legal, and employment issues than those with permanent housing. Although the relationship between housing status and clinical treatment outcomes is a complex one, some studies suggest that associations exist between stable housing, lower utilization of hospital services, and more positive treatment outcomes among certain populations. Permanent housing that is offered following or concurrent with recovery oriented and treatment focused integrated care models can result in improved clinical outcomes. The linkage between stable permanent housing and behavioral health services is critical for recovery. For many in recovery from substance use disorders, transitional drug-free housing is essential to achieving long-term recovery. Such "recovery housing" can be provided through a variety of models ranging from peer-run, self-supported, drug-free homes to community-based housing that includes a range of supportive services.SAMHSA has demonstrated that prevention works, treatment is effective, and people recover from mental, substance use, and co-occurring mental and substance use disorders. To continue to improve the delivery and financing of prevention, treatment and recovery support services, SAMHSA has identified eight Strategic Initiatives to focus the Agency's work on people and emerging opportunities. More information is available at the SAMHSA Web site: http://www.samhsa.gov/About/strategy.aspx. This program is aligned with all Strategic Initiatives and specifically Trauma and Justice, Military Families, and Recovery Support. The Cooperative Agreements to Benefit Homeless Individuals program is one of SAMHSA's services programs that supports infrastructure development at the community level. SAMHSA expects that the grantee will start delivering services as soon as possible after the award. Service delivery should begin by the 4th month of the project at the latest. Cooperative Agreements to Benefit Homeless Individuals are authorized under Section 506 of the Public Health Service Act, as amended, which states that grants may be made to entities that provide integrated primary health, substance abuse, and mental health services to homeless individuals. Pursuant to subsection (c) of Section 506 grantees may not refuse treatment or services to any individuals who present to the grantee with a mental disorder only or a substance use disorder only. This program is designed to improve and enhance the current SSH and GBHI programs. Similar to SSH and GBHI, this program emphasizes the importance of access to permanent housing and supportive services for individuals who are chronically homeless due to mental and substance use disorders and further strengthens the importance of integrating behavioral and primary care services. The primary goal of this program is to ensure that people who are chronically homeless due to mental and substance use disorders have a supportive, permanent place to live that promotes wellness and sustained recovery from addiction and mental disorders as well as access to integrated behavioral health and primary care services. This announcement addresses Healthy People 2020 Mental Health and Mental Disorders Topic Area HP 2020-MHMD and Substance Abuse Topic Area HP 2020-SA.DefinitionsFor the purposes of this RFA, the term "behavioral health" refers to a state of mental/emotional health and/or choices and actions that affect wellness. Behavioral health problems include substance abuse or misuse, alcohol and drug addiction, serious psychological distress, suicide, and mental and substance use disorders. The term is also used to describe the service systems encompassing the promotion of emotional health, the prevention of mental and substance use disorders and related problems, treatments and services for mental and substance use disorders, and recovery support."Mental and substance use disorders" are referred to throughout this document. This phrase is meant to be inclusive of mental disorders, substance use disorders, and co-occurring mental and substance use disorders."Permanent housing" means community-based housing without a designated length of stay (e.g., no limit on the length of stay). The phrase "permanent housing that supports recovery" refers to housing that is considered permanent (rather than temporary or short-term) and offers tenants a range of supportive services aimed at promoting recovery from mental and/or substance use disorders. There should not be any arbitrary limits for the length of stay for the tenant as long as the tenant complies with the lease requirements (consistent with local landlord-tenant law). "Chronic homelessness" as characterized under the McKinney-Vento Homeless Assistance Act, as amended by S. 896 of the "Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act of 2009 means, with respect to an individual or family, that the individual or family� (i) is homeless and lives or resides in a place not meant for human habitation, a safe haven, or in an emergency shelter; (ii) has been homeless and living or residing in a place not meant for human habitation, a safe haven, or in an emergency shelter continuously for at least 1 year or on at least 4 separate occasions in the last 3 years; and (iii) has an adult head of household (or a minor head of household if no adult is present in the household) with a diagnosable substance use disorder, serious mental illness, developmental disability, post traumatic stress disorder, cognitive impairments resulting from a brain injury, or chronic physical illness or disability, including the co-occurrence of 2 or more of those conditions." In addition, a person who currently lives or resides in an institutional care facility, including a jail, substance abuse or mental health treatment facility, hospital or other similar facility, and has resided there for fewer than 90 days shall be considered chronically homeless if such person met all of the requirements described above prior to entering that facility.The term "Community Consortium" is defined as an association or a combination of community-based programs, health and human service agencies, State and local government agencies for the purpose of engaging in a joint venture and having a cooperative arrangement among the group's members. For the purposes of this grant, the grantee may join an existing State/local Community Consortium or create a new Community Consortium.