System of Care (SOC) Expansion and Sustainability Cooperative Agreements

Substance Abuse & Mental Health Services Administration (SAMHSA) 

DEADLINE: Applications due April 25, 2016

AWARD: Anticipated total award amount of $52,905,470 with up to $3 million per year for state applicants and up to $1 million for political subdivisions of states, territories, and Indian or tribal organizations. The grant will last 4 years. 

Grantees are required to provide the statutory match requirements ($3 federal to $1 non-federal in years 1-3; $1 federal to $1 non-federal in year 4). 

NUMBER OF AWARDS: 17-53 awards.

ELIGIBILITY: Eligibility for this program is statutorily limited to public entities: State governments; Indian or tribal organizations (as defined in Section 4[b] and Section 4[c] of the Indian Self-Determination and Education Assistance Act); Governmental units within political subdivisions of a state, such as a county, city or town; District of Columbia government; and the Commonwealth of Puerto Rico, Northern Mariana Islands, Virgin Islands, Guam, American Samoa, and Trust Territory of the Pacific Islands (now Palau, Micronesia, and the Marshall Islands). 

TARGET POPULATION: Children and youth (birth-21) with serious emotional disturbances (SED) and those with early signs and symptoms of serious mental illness (SMI), including first episode psychosis (FEP), and their families.

  • Age: Children and youth from birth to 21 years of age.
  • Diagnosis: The child or youth must have an emotional, socio-emotional, behavioral, or mental disorder diagnosable under the current Diagnostic and Statistical Manual of Mental Disorders) (DSM) or ICD equivalents. For children three years of age or younger, the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood-Revised (DC: 0-3R) should be used as the diagnostic tool (or subsequent revisions). (See for more information.) For children four years of age and older, the Diagnostic Interview Schedule for Children (DISC) may be used as an alternative to the DSM.
  • Disability: The child or youth is unable to function in the family, school, or community, or in a combination of these settings; or the level of functioning is such that the child or adolescent requires multi-agency intervention involving two or more community service agencies providing services in the areas of mental health, education, child welfare, juvenile justice, substance abuse, or primary health care. For children under six years of age, community service agencies include those providing services in the areas of childcare, early childhood education (e.g., Head Start), pediatric care, and family mental health. For young adults ages 18 to 21 years, community service agencies include those providing services in the areas of adult mental health, social services, vocational counseling and rehabilitation, higher education, criminal justice, housing, and health.
  • Duration: The identified disability must have been present for at least one year or, on the basis of diagnosis, severity or multi-agency intervention, is expected to last more than one year.

Applications that will address the following areas of focus are encouraged:

  • Individuals that have, or are at serious risk of having, FEP;
  • Youth involved in other child serving agencies including, but not limited to:
  • Juvenile Justice, Primary Care, Child Welfare (including children who have been adopted), and Education;
  • Youth with co-occurring substance use disorders;
  • Early childhood (young children with SED); and
  • Infrastructure and service activities to improve integration between mental health and primary physical health care.

SUMMARY: The purpose of this program is to improve behavioral health outcomes for children and youth (birth-21) with serious emotional disturbances (SED) and their families. This program will support the widescale operation, expansion, and integration of the SOC approach by creating sustainable infrastructure and services that are required as part of the Comprehensive Community Mental Health Services for Children and their Families Program (also known as the Children’s Mental Health Initiative or CMHI). This cooperative agreement will support the provision of mental health and related recovery support services to children and youth with SED and those with early signs and symptoms of serious mental illness (SMI), including first episode psychosis (FEP), and their families. 

Applicants are expected to articulate their knowledge and vision for creating, expanding, and sustaining the family-driven and youth-guided SOC approach for addressing the needs of children and youth with serious emotional disturbances and their families. 

There are two levels of grant applications:

  1. SOC expansion and sustainability for states focused on statewide implementation. Applicants must identify in their application at least two local jurisdictions that have not received an implementation expansion grant (see Appendix III) to implement service innovations, and demonstrate how they will systematically expand the approach in additional localities over time. Letters of Commitment from local jurisdictions must be included in Attachment 1. If a state applicant submits an application with a local jurisdiction that is a current grantee (See Appendix III of the RFA), the application will be screened out and will not be reviewed.
  2. SOC expansion and sustainability for political subdivisions of states, tribes, tribal organizations, or territories focused on implementation within their jurisdiction. Applicants must demonstrate that they are working with their respective states (including State Medicaid Agencies) to achieve the broader systemic changes needed to expand and sustain SOC. In addition, applicants are required to demonstrate and/or create a linkage with the lead state agency for mental health services for youth, and specify how high-level systemic changes will be achieved that build on the work in their jurisdiction. Include in Attachment 1 letters from the state, tribal, or territory leadership demonstrating their commitment to broader system level changes to support the local level adoption of SOC.

The following are required activities designed to implement, expand, operate, and sustain SOCs:

  • The following mental health services shall be provided: (1) diagnostic and evaluation services; (2) outpatient services, including individual, group and family counseling services; professional consultation; and review and management of medications; (3) 24-hour emergency services, seven days a week; (4) intensive home-based services for the children and their families when the child is at imminent risk of out-of-home placement; (5) intensive day treatment services; (6) respite care; (7) therapeutic foster care services, services in therapeutic foster family homes or individual therapeutic residential homes, and group homes caring for not more than 10 children; (8) assisting the child in making the transition from services received as a child to the services to be received as an adult; and (9) other recovery support services (e.g., supported employment) and focus efforts to provide early treatment for those youth with early onset of SED/SMI.
  • Capacity building strategies for state/tribal and local levels to provide sustained service delivery to children, youth, and families shall be implemented. These shall include the review and revision of policies and regulations to improve service delivery to support expansion and sustainability requirements.
  • Services shall be delivered with cultural and linguistic competence and shall address issues of diversity and disparity.
  • Services shall be delivered within a family-driven, youth-guided/directed framework and engagement of family and youth shall be demonstrated through integral partnerships in their own treatment services and supports.
  • Families and youth shall be integrally involved in the planning, governance, implementation, evaluation, and oversight of grant activities and in the system planning efforts to expand and sustain SOCs.
  • Trauma-related activities shall be incorporated into the service system, including trauma screening, trauma treatment, and a trauma-informed approach to care. Implementing evidence-based and promising approaches to treatment while integrating mental health and substance abuse services, supports, and systems shall be implemented.
  • Mechanisms to promote and sustain youth and family participation shall be implemented (e.g., peer support; development of youth leadership; mentoring programs, and the partnership between family, adult consumer, and youth organizations; youth-guided activities; youth peer specialists; parent support providers establishing permanent youth and family advisory and evaluation bodies; and self-help organizations/programs).
  • Collaborations across child-serving agencies (e.g., substance use, child welfare, juvenile justice, primary care, education, early childhood) and among critical providers and programs to build bridges among partners, including relationships between community and residential treatment settings. Collaboration between child and adult serving agencies is critical when serving older youth who are transitioning to adulthood.
  • Workforce participation through the use of peer support providers (family and youth) shall be expanded.
  • Develop and implement an integrated crisis response strategy that creates a continuum of community-based crisis services and supports to reduce the unnecessary use of inpatient services by children and youth with SED.
  • Development of outreach and engagement strategies that identify and engage youth and families in SOC efforts, including those focusing on youth experiencing early onset of SED/SMI and other hard to reach populations.
  • Creation of flexible funds with agency policy support. Flex funds shall be used to support the individualized needs of children, youth, and families that are not typically covered services and otherwise not reimbursable. Use of flex funds shall be tied into an individual’s plan of care (i.e., treatment plan), and should be considered as a temporary solution to address a specific need.
  • Any youth enrolled in SOC case management services as a result of the grant should be included in the service delivery tracking data. This would include youth enrolled in services for which payment for services are made, or can reasonably be expected to be made under any state compensation program, under a private insurance policy, or under any federal or state health benefits program.