[Federal Register Volume 69, Number 56 (Tuesday, March 23, 2004)]
[Notices]
[Pages 13545-13548]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-6376]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration


Funding Opportunity Title: State Incentive Grants to Build 
Capacity for Alternatives to Restraint and Seclusion (Short Title: 
Alternatives to Restraint and Seclusion SIG)

    Announcement Type: Initial.
    Funding Opportunity Number: SM-04-007.
    Catalog of Federal Domestic Assistance (CFDA) Number: 93.243.
    Due Date for Applications: June 1, 2004.

    (Note: Letters from State Single Point of Contact (SPOC) in 
response to E.O. 12372 are due August 2, 2004.)

SUMMARY: The Substance Abuse and Mental Health Services Administration 
(SAMHSA), Center for Mental Health Services (CMHS), announces the 
availability of FY 2004 funds for State Incentive Grants to Build 
Capacity for Alternatives to Restraint and Seclusion. A synopsis of 
this funding opportunity, as well as many other Federal government 
funding opportunities, are also available at the Internet site: 
www.grants.gov.
    For complete instructions, potential applicants must obtain a copy 
of SAMHSA's standard Infrastructure Grants Program Announcement (INF-04 
PA (MOD)) and the (PHS 5161-1, Rev. 7/00) application form before 
preparing and submitting an application. The INF-04 PA (MOD) describes 
the general

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program design and provides instructions on how to apply for all SAMHSA 
Infrastructure Grants, including the Alternatives to Restraint and 
Seclusion SIG. Additional instructions and requirements specific to the 
Restraint and Seclusion SIG are described below.

I. Funding Opportunity Description

    Authority: Title 4. Public Health and Welfare, chapter 6A--
Public Health Service, subchapter III A--Substance Abuse and Mental 
Health Services Administration, part A Organization and General 
Authority, as amended, 42 U.S.C. 290aa et seq., the Children's 
Health Act of 2000, part H, Requirement Relating to the Rights of 
Residents of Certain Facilities (42 U.S.C. at 290ii-290ii-2), and 
part I, Requirement Relating to the Rights of Residents of Certain 
Non Medical, Community-based Facilities for Children and Youth (42 
U.S.C. at 290jj-1--290jj-2), and the Protection and Advocacy for 
Individuals with Mental Illness Act of 1986, as amended, (42 U.S.C. 
10801 et seq.).

    The Alternatives to Restraint and Seclusion SIG program is one of 
SAMHSA's Infrastructure Grants. SAMHSA's Infrastructure Grants provide 
funds to increase the capacity of mental health and/or substance abuse 
service systems to support programs and services.
    The purpose of the Alternatives to Restraint and Seclusion SIG 
program is to support States in their efforts to adopt best practices 
to reduce and ultimately eliminate the use of restraint and seclusion 
in institutional and community-based settings that provide mental 
health services (including services for people with co-occurring 
substance abuse and mental health disorders). Through the Alternatives 
to Restraint and Seclusion SIG program, States will: (1) Increase the 
number of programs that adopt best practices involving alternative 
approaches to reduce restraint and seclusion, including staff training 
models and other multi-faceted approaches; and (2) collect data to 
document the program's impact on reducing seclusion and restraint use 
and adoption of alternative practices.
    Background: Seclusion and restraint are often misused in the course 
of mental health care. Deaths and injuries due to seclusion and 
restraint are estimated at approximately 150 per annum across the 
nation. Children with serious emotional disturbances are especially at 
high risk for deaths and serious injury from these practices. Persons 
with co-occurring problems also appear at risk, as do elderly adults in 
nursing homes and other settings. In addition to the very real risk of 
death and injury, individuals who have experienced previous physical or 
sexual abuse can suffer further traumatization when subjected to these 
practices. This effort builds on the existing SAMHSA/CMHS grant program 
begun in FY 2001, to identify effective alternative practices, 
including training efforts, to reduce restraint and seclusion 
practices, and will promote the application of the findings from that 
grant program. Additional resources related to restraint and seclusion 
best practices are listed in the Appendix to this document.

II. Award Information

    1. Estimated Funding Available/Number of Awards: It is expected 
that up to $1.9 million will be available to fund up to eight awards in 
FY 2004. The maximum allowable award is $237,000 in total costs (direct 
and indirect) per year for up to three years. Proposed budgets cannot 
exceed the allowable amount in any year of the proposed project. The 
actual amount available for the awards may vary, depending on 
unanticipated program requirements and the number and quality of the 
applications received. Annual continuations will depend on the 
availability of funds, grantee progress in meeting program goals and 
objectives, and timely submission of required data and reports.
    2. Funding Instrument: Grant.

III. Eligibility Information

    1. Eligible Applicants are agencies of States, the District of 
Columbia, Territories and Native American tribal governments (federally 
recognized) with jurisdiction over mental health issues for the target 
population identified in the proposed project. The statutory authority 
for this program prohibits grants to for-profit organizations. Eligible 
applicants must have the capacity to report incidents to their State 
Protection and Advocacy system, specifically the Protection and 
Advocacy for Individuals with Mental Illness (PAIMI) Program, as 
required under the Children's Health Act of 2000. These eligibility 
criteria supersede the criteria specified in section III-1 of the INF-
04 PA (MOD).
    2. Cost Sharing or Matching is not required.
    3. Other: Applicants must also meet certain application formatting 
and submission requirements or the application will be screened out and 
will not be reviewed. These requirements are described in section IV-2 
below as well as in the INF-04 PA (MOD).
    Documentation of Eligibility--Applicants must demonstrate that they 
are currently in compliance with provisions of the Children's Act of 
2000, pertaining to the use of restraint and seclusion, by providing 
the following documentation in Appendix 6, ``Restraint and Seclusion 
Documentation,'' of their applications (there are no page limitations 
for Appendix 6):
    (1) A copy of the State's administrative procedures, regulations, 
or statutes addressing issues related to restraint and seclusion.
    (2) Policies and procedures related to certification of facility 
personnel in issues related to restraint and seclusion. Minimum 
educational requirements of staff authorized to approve restraint and 
seclusion techniques must also be provided. If there are no such 
requirements, a statement to that effect must be included.
    (3) The State's reporting requirements related to serious injury 
and/or death resulting from restraint and seclusion techniques, 
including the process for sharing this information with the State's 
Protection and Advocacy Agency.

IV. Application and Submission Information

    1. Address to Request Application Package: Complete application 
kits may be obtained from the National Mental Health Information Center 
at 1-800-789-2647. When requesting an application kit for this program, 
the applicant must specify the funding opportunity title (Alternatives 
to Restraint and Seclusion SIG) and the funding opportunity number (SM 
04-007) for which detailed information is desired. All information 
necessary to apply, including where to submit applications and 
application deadline instructions, are included in the application kit. 
The PHS 5161-1 application form is also available electronically via 
SAMHSA's World Wide Web home page: http://www.samhsa.gov (Click on 
``Grant Opportunities'') and the INF-04 PA (MOD) is available 
electronically at http://www.samhsa.gov/grants/2004/standard/Infrastructure/index.asp.
    When submitting an application, be sure to type ``SM 04-007/
Alternatives to Restraint and Seclusion SIG'' in Item Number 10 on the 
face page of the application form. Also, SAMHSA applicants are required 
to provide a DUNS Number on the face page of the application. To obtain 
a DUNS Number, access the Dun and Bradstreet Web site at 
www.dunandbradstreet.com or call 1-866-705-5711.
    2. Content and Form of Application Submission: Information 
including required documents, required application components, and

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application formatting requirements are available in the INF-04 PA 
(MOD) in Section IV-2.

Checklist for Formatting Requirements and Screenout Criteria for SAMHSA 
Grant Applications

    SAMHSA's goal is to review all applications submitted for grant 
funding. However, this goal must be balanced against SAMHSA's 
obligation to ensure equitable treatment of applications. For this 
reason, SAMHSA has established certain formatting requirements for its 
applications. If you do not adhere to these requirements, your 
application will be screened out and returned to you without review.
--Use the PHS 5161-1 application.
--Applications must be received by the application deadline. 
Applications received after this date must have a proof of mailing date 
from the carrier dated at least 1 week prior to the due date. Private 
metered postmarks are not acceptable as proof of timely mailing. 
Applications not received by the application deadline or not postmarked 
at least 1 week prior to the application deadline will not be reviewed.
--Information provided must be sufficient for review.
--Text must be legible.

     Type size in the Project Narrative cannot exceed 
an average of 15 characters per inch, as measured on the physical page. 
(Type size in charts, tables, graphs, and footnotes will not be 
considered in determining compliance.)
     Text in the Project Narrative cannot exceed 6 
lines per vertical inch.

--Paper must be white paper and 8.5 inches by 11.0 inches in size.
--To ensure equity among applications, the amount of space allowed for 
the Project Narrative cannot be exceeded.

     Applications would meet this requirement by 
using all margins (left, right, top, bottom) of at least one inch each, 
and adhering to the page limit for the Project Narrative stated in the 
specific funding announcement.
     Should an application not conform to these 
margin or page limits, SAMHSA will use the following method to 
determine compliance: The total area of the Project Narrative 
(excluding margins, but including charts, tables, graphs and footnotes) 
cannot exceed 58.5 square inches multiplied by the page limit. This 
number represents the full page less margins, multiplied by the total 
number of allowed pages.
     Space will be measured on the physical page. 
Space left blank within the Project Narrative (excluding margins) is 
considered part of the Project Narrative, in determining compliance.

--The page limit for Appendices stated in the specific funding 
announcement cannot be exceeded.
--To facilitate review of your application, follow these additional 
guidelines. Failure to adhere to the following guidelines will not, in 
itself, result in your application being screened out and returned 
without review. However, the information provided in your application 
must be sufficient for review. Following these guidelines will help 
ensure your application is complete, and will help reviewers to 
consider your application.
--The 10 application components required for SAMHSA applications should 
be included. These are:

     Face Page (Standard Form 424, which is in PHS 
5161-1);
     Abstract;
     Table of Contents;
     Budget Form (Standard Form 424A, which is in PHS 
5161-1);
     Project Narrative and Supporting Documentation;
     Appendices;
     Assurances (Standard Form 424B, which is in PHS 
5161-1);
     Certifications (a form in PHS 5161-1);
     Disclosure of Lobbying Activities (Standard Form 
LLL, which is in PHS 5161-1);
     Checklist (a form in PHS 5161-1).

--Applications should comply with the following requirements:

     Provisions relating to confidentiality, 
participant protection and the protection of human subjects, as 
indicated in the specific funding announcement.
     Budgetary limitations as indicated in sections 
I, II, and IV-5 of the specific funding announcement.
     Documentation of nonprofit status as required in 
the PHS 5161-1.

--Pages should be typed single-spaced with one column per page.
--Pages should not have printing on both sides.
--Please use black ink, and number pages consecutively from beginning 
to end so that information can be located easily during review of the 
application. The cover page should be page 1, the abstract page should 
be page 2, and the table of contents page should be page 3. Appendices 
should be labeled and separated from the Project Narrative and budget 
section, and the pages should be numbered to continue the sequence.
--Send the original application and two copies to the mailing address 
in the funding announcement. Please do not use staples, paper clips, 
and fasteners. Nothing should be attached, stapled, folded, or pasted. 
Do not use heavy or lightweight paper, or any material that cannot be 
copied using automatic copying machines. Odd-sized and oversized 
attachments such as posters will not be copied or sent to reviewers. Do 
not include videotapes, audiotapes, or CD-ROMs.

    3. Submission Dates and Times: Applications must be received by 
June 1, 2004. You will be notified by postal mail that your application 
has been received. Additional information is available in the INF-04 PA 
(MOD) in section IV-3.
    4. Intergovernmental Review: Applicants for this funding 
opportunity must comply with Executive Order 12372 (E.O.12372). 
E.O.12372, as implemented through Department of Health and Human 
Services regulation at 45 CFR part 100, sets up a system for State and 
local review of applications for Federal financial assistance. 
Instructions for complying with E.O. 12372 are provided in the INF-04 
PA (MOD) in section IV-4. A current listing of State Single Points of 
Contact (SPOCs) is included in the application kit and is available at 
www.whitehouse.gov/omb/grants/spoc.html.
    5. Funding Restrictions: Information concerning funding 
restrictions is available in the INF-04 PA (MOD) in section IV-5.

V. Application Review Information

    1. Evaluation Criteria: Applications will be reviewed against the 
Evaluation Criteria and requirements for the Project Narrative 
specified in the INF-04 PA (MOD). The following information describes 
exceptions or limitations to the INF-04 PA (MOD) and provides special 
requirements that pertain only to Alternatives to Restraint and 
Seclusion SIG grants. Applicants must discuss the following 
requirements in their applications, in addition to the requirements 
specified in the INF-04 PA (MOD):
    1.1 In ``Section A: Statement of Need'': a. Applicants must 
identify the age group that will be targeted through the proposed 
project. Grantees may address any group(s) across the lifespan, but 
must target adults with serious mental illnesses (SMI) and/or children/
youth with serious emotional disturbances (SED), including persons

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with SMI, co-occurring disorders or other disabilities.
    b. Applicants must report on the following outcome indicators. This 
information must be provided in total and by race/ethnicity, gender and 
diagnosis:
    (1) The number of incidents involving the use of restraint and 
seclusion for calendar years 2002 and 2003 (January 1, 2002--December 
31, 2003).
    (2) The number and types of injuries (minor to severe) related to 
incidents involving the use of restraint and seclusion for calendar 
years 2002 and 2003 (January 1, 2002--December 31, 2003).
    (3) The number of deaths related to incidents involving the use of 
restraint and seclusion for calendar years 2002 and 2003 (January 1, 
2002--December 31, 2003).
    (4) The number of facilities within the State, territory or tribe 
in which administrators are implementing alternatives to the use of 
restraint and seclusion.
    1.2 In ``Section B: Proposed Approach'': Applicants must identify 
the best practice that is being proposed for implementation. Resources 
to assist in identifying restraint and seclusion best practices are 
provided in the Appendix at the end of this NOFA.
    1.3 Performance Measurement: All SAMHSA grantees are required to 
collect and report certain data, so that SAMHSA can meet its obligation 
under the Government Performance and Results Act (GPRA). Applicants 
must document their ability to collect and report data on these 
indicators in ``Section D: Evaluation and Data,'' of their Project 
Narrative. SAMHSA will work with grantees to finalize a standard 
methodology related to these indicators shortly after award, and will 
seek the Office of Management and Budget's approval for use of these 
indicators by the grantees. Grantees of the Alternatives to Restraint 
and Seclusion SIG program will be required to report on the following 
performance indicators:
    (1) The number of programs that adopt best practices involving 
alternative approaches to reduce restraint and seclusion, including 
staff training models and other multi-faceted approaches.
    (2) The number of incidents of the use of restraint and seclusion 
techniques.
    (3) In addition, you must document which of the following variables 
you have the ability to collect and report on. CMHS will select a set 
of core measures from among these measures that all grantees will be 
required to report on post award.
    (a) Temporal data (e.g., time of day, day of week, special events/
holidays);
    (b) Episode location;
    (c) Episode precipitants (e.g., assaults on staff, assaults on 
peers, property damage);
    (d) Gender;
    (e) Age;
    (f) Race/ethnicity;
    (g) Developmental/cognitive age;
    (h) Unit/program where the individual is housed or treated;
    (i) Precipitous discharges;
    (j) Monitoring;
    (k) Debriefing;
    (l) Restraint types used (e.g., prone, seated, mechanical, etc.).
    1.4 Additional Information: Applicants should be aware that a 
Coordination Center will be established through a separate contract to 
collect and analyze data from grantees, assess the impact of the 
grants, and act as a resource center to States and others on restraint 
and seclusion. The Coordination Center also will provide technical 
support and information to increase capacity of grantees and others to 
adopt best practices.
    2. Review and Selection Process: Information about the review and 
selection process is available in the INF-04 PA (MOD) in Section V-2.

VI. Award Administration Information

    Award administration information, including award notices, 
administrative and national policy requirements, and reporting 
requirements are available in the INF-04 PA (MOD) in Section VI. 
SAMHSA's standard terms and conditions are available at www.samhsa.gov/grants/2004/useful_info.asp.

VII. Agency Contact for Additional Information

    For questions about program issues contact: Karen Armstrong, 
SAMHSA/CMHS, 5600 Fishers Lane, Room 15C-21, Rockville, MD 20857; 301-
443-3667; e-mail: [email protected]. For questions on grants 
management issues contact: Gwendolyn Simpson, SAMHSA/Division of Grants 
Management, 5600 Fishers Lane, Room 13-103, Rockville, MD 20857; 301-
443-4456; e-mail: [email protected].

Appendix--Resources Related to Restraint and Seclusion Best Practices

    1. Leading the Way Toward a Seclusion and Restraint Free 
Environment--Pennsylvania's Success Story, Office of Mental Health 
and Substance Abuse Services, Commonwealth of Pennsylvania, 
(Hardenstine, B., October 2001).
    2. Reducing the Use of Seclusion and Restraint, the National 
Association of State Mental Health Program Directors (1999-2002).
    3. Learning from Each Other, the American Psychiatric 
Association, the American Psychiatric Nurses Association, and the 
National Association of Psychiatric Health Systems (2003).
    4. The Use of Restraints, Seclusion and Exclusion in State 
Mental Hospitals and Restoration Center, the Office of Mental Health 
and Substance Abuse, Department of Public Welfare, the Commonwealth 
of Pennsylvania (SMH-01-02, June 2001).
    5. Reporting Abuses of Persons with Disabilities, Department of 
Health and Human Services, Office of Inspector General, May 2001, A-
01-00-02502.
    6. Partnership Beyond Restraints: A Statewide Educational 
Intervention to Reduce Restraint Use, Annals of Long-Term Care, 
American Geriatric Society, Dunbar, J, and Neufeld, R., May 2002.
    7. Improper Restraint or Seclusion Use Places People at Risk, 
United States Government Accounting Office (GAO), September 1999, 
GAO/HEHA-99-176.
    8. Deadly Restraint, Hartford Courant, a Connecticut newspaper 
(October 1998).
    9. ``Is It Meant to Hurt, Is It?''--Management of Violence in 
Women with Developmental Disabilities, Violence Against Women, 
Halstead, S. H., (April 2001).
    10. Treatment and Management of Challenging Behaviors in 
Residential Settings, Journal of Applied Research in Intellectual 
Disabilities, Emerson E. et al., 2000.
    11. Seclusion and Restraint: A Review of Recent Literature, 
Harvard Review of Psychiatry, Busch AB, Shore MF, (November 2000).
    12. Staff Training Decreases Use of Seclusion and Restraint in 
an Acute Psychiatric Hospital, Archives of Psychiatric Nursing, 
Forster PL, Cavness C., (October 1999).
    13. Behavior Management: Best Practices, Child Welfare League of 
America (2001).
    14. Reducing the Use of Restraint and Seclusion: Promising 
Practices and Successful Strategies, Child Welfare League of 
America, Bullard, L., Fulmore, D. et al. (2003).
    15. Practicing Restraint, Children's Voice, Kirkwood, Scott, 
(September/October 2003).

    Dated: March 17, 2004.
Margaret M. Gilliam,
Acting Director, Office of Policy, Planning and Budget, Substance Abuse 
and Mental and Mental Health Services Administration.

[FR Doc. 04-6376 Filed 3-22-04; 8:45 am]
BILLING CODE 4162-20-P