[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]
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