A disparity impact statement (DIS) is required for all grants submitted to SAMHSA. It is a critical response that must meet SAMHSA’s public health mission and may focus on the special or unique mental health and substance use issues in specific populations in the U.S. Populations of interest include: racial and ethnic minority; age- and gender-based populations; lesbian, gay bisexual (LBGT) individual; people who live in rural areas; people experiencing homelessness; people involved with the criminal justice system; and veterans and military families. While this may seem to be an extensive special population list, each group has specific barriers in care with high risk for morbidity and engagement needs. It is important to know your service population and the overlay of how SAMSHA’s public health mission addresses their needs.
SAMSHA’s health disparity action plan is reflective of the HHS Action Plan to Reduce Racial and Ethnic Disparities and has guiding points for SAMHSA’s Six Strategic Initiatives in Leading Change 2.0: Advancing the Behavioral Health of the Nation 2015-2018. The Six Strategic Initiatives are:
- Prevention of Substance Abuse and Mental Illness,
- Health Care and Health Systems Integration,
- Trauma and Justice,
- Recovery Support,
- Health Information Technology, and
- Workforce Development.
Within these initiatives, the narrative for the grant proposal must clearly state the specific behavioral health disparity and the impact point for the effective prevention, treatment and service for the special population. The narrative must align with SAMHSA’s goals to:
- guide the behavioral health system,
- promote individual, program, and system-level approaches that foster health and resilience (including helping individuals with behavioral health needs be well, manage symptoms, and achieve and maintain abstinence),
- increase housing to support recovery,
- reduce barriers to employment, education, and other life goals, and
- secure necessary social supports.
SAMSHA provides disparity impact examples for services, infrastructure, training/technical assistance, tribal grantees, and PATH grantees. Planning for this element in the proposal narrative must be quantitative, direct, and reflective of your specific program engagement successes and projections. Data is essential to show need, experience, capacity, and outcome in response to the health disparity initiatives and special population needs. Additionally, a responsive narrative must also include how data will be used to allow quality improvement plans and actions supportive of cultural and linguistic needs of participants. Knowledge of theCulturally and Linguistically Appropriate Services (CLAS) in Health and Health Care will structure the response based on service population:
- diverse cultural health beliefs and practices,
- preferred languages,
- health Literacy, and
- other communication needs.
Building a competitive proposal for a SAMSHA grant involves a multi-step process that must include a compelling narrative responsive to the goals of the FOA and have a clear and concise DIS.