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Intergovernmental

     Department of Health and Human Services

    Substance Abuse and Mental Health Services Administration

    Center for Substance Abuse Treatment

    Projects to Deliver and Evaluate

    Peer-to-Peer Recovery Support Services

    Short Title: Recovery Community Services Program RCSP

    (Initial Announcement)

    Request for Applications (RFA) No. TI-06-004

Catalogue of Federal Domestic Assistance (CFDA) No.: 93.243

    Key Dates:

Application Deadline April 4, 2006

    Intergovernmental Review Letters from State Single Point of Contact (SPOC) are due no (E.O. 12372) later than 60 days after application deadline.

    Public Health System Impact Applicants must send the PHSIS to appropriate State and local Statement (PHSIS)/Single health agencies by application deadline. Comments from Single

    State Agency Coordination State Agency are due no later than 60 days after application

    deadline.

     _________________________________

    H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM Charles G. Curie, M.A., A.C.S.W.

    Director, Center for Substance Abuse Treatment Administrator Substance Abuse and Mental Health Substance Abuse and Mental Health

     Services Administration Services Administration

    Table of Contents

    I. FUNDING OPPORTUNITY DESCRIPTION .....................................................................3 1. INTRODUCTION ...........................................................................................................3 2. EXPECTATIONS ...........................................................................................................3 II. AWARD INFORMATION .................................................................................................9 1. AWARD AMOUNT........................................................................................................9 2. FUNDING MECHANISM ..............................................................................................9 III. ELIGIBILITY INFORMATION .........................................................................................9 1. ELIGIBLE APPLICANTS ..............................................................................................9 2. COST-SHARING .......................................................................................................... 10 3. OTHER ......................................................................................................................... 10

    IV. APPLICATION AND SUBMISSION INFORMATION ................................................... 11 1. ADDRESS TO REQUEST APPLICATION PACKAGE ............................................... 11

    2. CONTENT AND FORM OF APPLICATION SUBMISSION....................................... 11

    3. SUBMISSION DATES AND TIMES ........................................................................... 17 4. INTERGOVERNMENTAL REVIEW (E.O. 12372) REQUIREMENTS ....................... 18

    5. FUNDING LIMITATIONS/RESTRICTIONS ............................................................... 20 6. OTHER SUBMISSION REQUIREMENTS .................................................................. 22 V. APPLICATION REVIEW INFORMATION ..................................................................... 23 1. EVALUATION CRITERIA .......................................................................................... 23 2. REVIEW AND SELECTION PROCESS ...................................................................... 32 VI. AWARD ADMINISTRATION INFORMATION ............................................................. 32 1. AWARD NOTICES ...................................................................................................... 32 2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS ......................... 33

    3. REPORTING REQUIREMENTS .................................................................................. 33 VII. AGENCY CONTACTS .................................................................................................... 35 APPENDIX A: LISTING OF CURRENT ACCESS TO RECOVERY (ATR) GRANTS ......... 36

    APPENDIX B: REFERENCES CITED.................................................................................... 42 APPENDIX C: PEER-TO-PEER RECOVERY SUPPORT SERVICES EXAMPLES.............. 43

    APPENDIX D: CHECKLIST FOR FORMATTING REQUIREMENTS AND SCREENOUT

    CRITERIA FOR SAMHSA GRANT APPLICATIONS ............................................................ 46 APPENDIX E: CORE VALUES FOR RCSP PEER-TO-PEER RECOVERY SUPPORT

    SERVICES ............................................................................................................................... 48

    APPENDIX F: SAMPLE CONSENT FORM FOR PARTICIPATION IN PEER-TO-PEER

    RECOVERY SUPPORT SERVICES ........................................................................................ 49 APPENDIX G: ANALYSIS OF EXAMPLES OF RISKS AND PROTECTIONS FOR PEER

    RECOVERY SUPPORT SERVICES ........................................................................................ 51 APPENDIX H: ADDITIONAL CONSIDERATION: PEER VS. PROFESSIONAL SUPPORT

    SERVICES ............................................................................................................................... 54

    APPENDIX I: GLOSSARY ..................................................................................................... 55 APPENDIX J: STATEMENT OF ASSURANCE .................................................................... 56 APPENDIX K: SAMPLE RCSP BUDGET .............................................................................. 57

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I. FUNDING OPPORTUNITY DESCRIPTION

1. INTRODUCTION

    The Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment (CSAT) announces the availability of FY 2006 funds for grants to

    deliver and evaluate peer-to-peer recovery support services that help prevent relapse and

    promote sustained recovery from alcohol and drug use disorders. Successful applicants will provide peer-to-peer recovery support services that are responsive to community needs and strengths, and will carry out a quantitative and qualitative evaluation of the services. Recovery Community Services Program (RCSP) grants are authorized under section 509 of the Public Health Service Act, as amended. This announcement addresses Healthy People 2010 focus area 26 (Substance Abuse).

    This Recovery Community Services Program complements SAMHSA’s Access to Recovery (ATR) program. ATR provides grant funding to States, Territories, and Tribal Organizations to implement voucher programs for substance abuse clinical treatment and recovery support services pursuant to sections 501(d)(5) and 509 of the Public Health Service Act (42 U.S.C. sections 290aa(d)(5) and 290bb-2). ATR is part of a major Presidential Initiative to provide client choice among substance abuse clinical treatment and recovery support service providers, expand access to a comprehensive array of clinical treatment and recovery support options (including faith-based programmatic options), and increase substance abuse treatment capacity.

    If you are applying for an RCSP grant and you are from a State that currently has a SAMHSA-funded ATR program, you must discuss in your application how you propose to link your RCSP project with the ATR program in your State. This is to ensure that RCSP applications complement the ATR program. (Note: Appendix A includes a listing of current ATR grantees

    and descriptions of the projects.)

2. EXPECTATIONS

2.1 Target/Involved Population

    The primary target for this program is people with a history of alcohol and/or drug problems who are in or seeking recovery, along with their family members and significant others, who will be both the providers and recipients of recovery support services. For purposes of this document, the term peer means people who share the experience of addiction and recovery, either directly or as family members/significant others.

2.2 Eligible Services

    Peer-to-peer recovery support services are designed and delivered by peers rather than by professionals. Professionals will be good allies, and successful peer initiatives will network and build strong and mutually supportive relationships with formal systems and professionals in their communities. However, peer services will be designed and delivered primarily by individuals in recovery to meet the targeted community’s recovery support needs, as the community defines

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    them. Therefore, although supportive of formal treatment, peer recovery support services are not treatment in the commonly understood clinical sense of the term.

    At the same time, peer recovery support services are expected to extend and enhance the treatment continuum in at least two ways. These services will help prevent relapse and promote long-term recovery, thereby reducing the strain on the over-burdened treatment system. Moreover, when individuals do experience relapse, recovery support services can help minimize the negative effects through early intervention and, where appropriate, timely referral to treatment.

    Continued sobriety or abstinence (which includes abstinence attained with medication, such as methadone or buprenorphine) is an important part of sustained recovery from addiction. However, recovery is a larger construct than sobriety or abstinence that embraces a reengagement with the community based on resilience, health, and hope. Therefore, peer recovery support services are expected to focus less on the pathology of substance use disorders and more on maximizing the opportunities to create a lifetime of recovery and wellness for self, family, and community. Appendix C provides a listing of examples of peer-to-peer recovery

    support services.

    This grant program is not designed to support the provision of professional treatment services of any kind, including aftercare, by any type of provider. Peer support services

    cannot replace acute treatment, and it would be unethical to utilize peer leaders from the recovery community to provide services, such as treatment, counseling, or psychotherapy, that should be provided by a professional. Peer leaders providing recovery support services under this program will offer supportive services that differ from and complement those provided by alcohol and drug counselors, psychotherapists, or other professionals.

    In addition, the program is not designed to support counselors, psychotherapists, other treatment providers, or other professionals of any kind in the provision of recovery support services. Individuals who self-identify as both a professional and a person in recovery may provide recovery support services in their capacity as a peer, but may not provide professional services under this grant.

    RCSP is intended to support peer leaders from the recovery community in providing recovery support services to people in recovery and their family members.

2.3 Mix of Services

    Applicants must demonstrate that the array of services offered is responsive to community need and complements existing community resources. Applications proposing culturally-specific peer recovery support models are welcome, as are applications proposing to serve specific populations needing or in recovery, such as veterans, people with disabilities, and other segments of the recovery community. The goal is to add to the existing resources in the community with peer-to-peer recovery support services that can meet the stage-appropriate needs of people who are seeking to initiate recovery or working to sustain it. Successful peer-to-peer recovery

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    support services will include ongoing assessment of participants’ support needs and a menu of supportive services to meet the needs at various stages in recovery.

    Because peer recovery support services operationalize the construct of social support, it may be helpful for applicants to consider four types of social support cited in the literature (Cobb, 1976; Salser, 2002), and to design a mix of services that includes activities in the following categories:

    ; Emotional support refers to demonstrations of empathy, caring, and concern that bolster

    one’s self-esteem and confidence. Peer mentoring, peer coaching, and peer-led support

    groups are examples of peer-to-peer recovery support services that provide emotional support.

    ; Informational support involves assistance with knowledge, information, and skills. This type

    of support can include providing information on where to go for resources or might involve

    teaching a specific skill. Examples of peer recovery support services that provide

    informational support include peer-led life skills training (e.g., parenting, stress management,

    conflict resolution), job skills training, citizenship restoration, educational assistance, and

    health and wellness information (e.g., smoking cessation, nutrition, relaxation training).

    ; Instrumental support refers to concrete assistance in helping others do things or get things

    done, especially stressful or unpleasant tasks. Examples in this category might include

    providing transportation to get to support groups, child-care, clothing closets, and concrete

    assistance with tasks such as filling out applications or helping people obtain entitlements.

    ; Affiliational support offers the opportunity to establish positive social connections with other

    recovering people. It is important for people in recovery to learn social and recreational

    skills in an alcohol- and drug-free environment. Especially in early recovery when there

    may be little that is reinforcing about abstaining from alcohol or drugs alcohol- and drug-

    free socialization may help prevent relapse [Meyers & Squires, 2001; Miller, Meyers &

    Hiller-Sturmhofel, 1999). In addition, community and cultural connections can be important

    in helping the recovering person establish a new identity around health and wellness as

    opposed to an identity formed in relation to the cultures of alcohol and drugs (Coyhis, 2002).

    Based on assessment of the targeted recovery community, the applicant should determine which services, and in which proportion, are expected to be optimally responsive to community needs. Note: Although alcohol- and drug-free socialization is an acceptable service under this grant, applicants may not limit their services to socialization activities, but, rather, must include a broad range of services from the various social support categories.

2.4 Core Values

    Applicants must identify the core values that will guide their approach, and explain how these values will be operationalized in the design and delivery of peer-to-peer recovery support services. Applicants must discuss each of the following values, which are further explained in

    Appendix E: (a) keeping recovery first; (b) participatory process; (c) authenticity of peers helping peers; (d) leadership development, and (e) cultural diversity and inclusion. Applicants

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    may identify and discuss other values important to the targeted recovery community, but must discuss these five.

2.5 Types of Peer Service Organizations

Applications may be submitted by either independent recovery community organizations (RCOs)

    or facilitating organizations (FOs).

    RCOs are organizations comprised of and led primarily by people in recovery and their family members. Generally, these are independent organizations with nonprofit status.

    FOs may not necessarily be comprised primarily of people in recovery. The FO will host a peer-run recovery support service program and will ensure that people in recovery are involved in all aspects of application development, program design, and implementation. Examples of facilitating organizations include: treatment and mental health agencies, community service centers, consortia of community-based organizations not led by recovery community members, universities, and units of government.

    Treatment providers, units of government, universities, and all other professionally-based organizations may apply only as FOs.

    Members of the recovery community must have a meaningful leadership role in any project, whether carried out by an RCO or FO.

    Grantees must begin delivering peer-to-peer recovery support services within 6 months of award. In order to comply, it is necessary for an applicant to be an established entity (with a viable organizational infrastructure, including appropriate governance, management, and fiscal management capabilities) and to have experience as a service provider. Applicants must clearly describe their operating experience in their Project Narrative.

2.6 Infrastructure Development (maximum 15% of total grant award)

    Organizations funded under RCSP must be sufficiently established and experienced to begin implementing peer recovery support services within 6 months of award. However, SAMHSA

    recognizes that infrastructure development may be needed to support organization development, in relation to project start-up, as well as service design, in some instances. Although the majority of grant funds should be used for direct services, you may use up to 15% of the total RCSP grant award for the following types of infrastructure development, if necessary, to support the design, development, and initiation of the peer services you will offer:

    ; Activities related to organizational and project start-up; for example, staff and board

    development, and enhancements to existing organizational functions, such as risk

    management, record-keeping, and accounting services.

    ; Community assessment and development. (Although you must demonstrate knowledge of

    community needs and resources in your application, if you are funded, you may use a limited

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    amount of grant funds to conduct additional assessments and refine your service plan, and to

    further mobilize the targeted recovery community to participate in the program.)

    ; Building partnerships and entering into service delivery or other agreements to ensure the

    success of the project.

    It is expected that peer leadership development (e.g., recruiting, orienting, training, and supervising peers to provide services) will be an ongoing activity. Peer leadership development is not considered infrastructure development.

2.7 Data and Performance Measurement

    Performance Measurement: All SAMHSA grantees are required to collect and report certain data so that SAMHSA can meet its obligations under the Government Performance and Results Act (GPRA). Grantees will be required to report performance in several areas relating to the client's substance use, family and living condition, employment status, social connectedness, access to treatment, retention in treatment and criminal justice status. This information will be gathered using the data collection tool referenced below. The collection of these data will enable CSAT to report on the National Outcome Measures (NOMs), which have been defined by SAMHSA as key priority areas relating to substance use.

    The purpose of the RCSP GPRA data is to provide information that helps to establish the value of peer-to-peer recovery support services in preventing relapse and promoting sustained recovery. To accomplish this, you will be required to provide data on a set of required performance indicators.

For adults and adolescents/youth receiving services, GPRA indicators include changes in a

    positive direction or stability over time on each of the following measures, showing that participants receiving your services:

    ? Have not used illegal drugs or misused alcohol or prescription drugs during the past month. ? Are currently employed or engaged in productive activities.

    ? Have reduced their involvement with the criminal justice system.

    ? Have a permanent place to live in the community.

    ? Have increased or maintained positive social connections.

    ? Have experienced increased access to recovery support and other services. ? Are being retained in your program.

    Please note: Although SAMHSA recognizes the important role that family members and significant others can play in supporting an individual’s recovery, the GPRA tool is not appropriate for family members or others who are not themselves in recovery. Therefore, although you may propose activities and services for family members, you should not plan to conduct GPRA performance data collection and reporting for individuals who are not personally in recovery from substance use disorders.

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    Applicants must document their ability to collect and report the required data in "Section D: Evaluation and Data" of their applications. You should not, however, include GPRA data collection forms. If you do not have the capability to collect and report on the GPRA measures, you will need to partner with an individual or organization that does.

    Grantees must collect and report data using the Discretionary Services Client Level GPRA tool, which can be found at www.samhsa-gpra.samhsa.gov (click on CSAT-GPRA, then click on

    "Data Collection Tools/Instructions"), along with instructions for completing it. Hard copies are available in the application kits distributed by SAMHSA's National Clearinghouse for Alcohol and Drug Information.

    GPRA data must be collected at baseline (i.e., the client's entry into the project), discharge, and 6 months after the baseline. After GPRA data are collected, data must then be entered into CSAT's GPRA Data Entry and Reporting System (www.samhsa-gpra.samhsa.gov) within 7 business

    days of the forms being completed. In addition, 80% of the participants must be followed up.

    Training and technical assistance on data collecting, tracking, and follow-up, as well as data entry, will be provided by CSAT.

    The terms and conditions of the grant award also will specify the data to be submitted and the schedule for submission. Grantees will be required to adhere to these terms and conditions of award.

2.8 Evaluation

    Grantees must evaluate their projects, and you are required to describe your evaluation plans in your application. The evaluation should be designed to provide regular feedback to the project to improve services. The evaluation must include the required GPRA performance measures (outcome evaluation) described above, as well as process components (process evaluation - described below), which measure change relating to project goals and objectives over time compared to baseline information. Control or comparison groups are not required.

Process components should address issues such as:

    ; How closely did implementation match the plan?

    ; What types of deviation from the plan occurred?

    ; What led to the deviations?

    ; What effect did the deviations have on the planned intervention and evaluation?

    ; Who provided (program staff, peer leaders) what services (modality, type, intensity,

    duration), to whom (individual characteristics), in what context (organization,

    community), and at what cost (facilities, personnel, dollars)?

    You may use no more than 20% of the total grant award for evaluation and data collection, including GPRA.

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2.9 Grantee Meetings

    There are 2 meetings per year. You must plan to send at least two to three key staff members (including the Project Director) to a yearly technical assistance meeting, and you must plan to send approximately 5-8 representatives of your project, including key staff and peer leaders from your targeted recovery community, to a yearly RCSP conference. You must include funding for this travel in your budget. At these meetings, grantees will present the results of their projects and Federal staff will provide technical assistance. Each meeting will be 3 days. These meetings will usually be held in the Washington, D.C., area, and attendance is mandatory.

II. AWARD INFORMATION

1. AWARD AMOUNT

    It is expected that approximately $2.5 million will be available in fiscal year 2006 to fund approximately 7 grants. The average annual award is expected to be about $350,000 in total costs (direct and indirect), and grants will be awarded for a period of up to 4 years.

    Out of the $2.5 million available, SAMHSA/CSAT plans to set aside approximately $1.4 million to fund up to 4 RCOs (as defined in Section I-2.5, entitled Types of Peer Services Organizations).

Proposed budgets cannot exceed $350,000 in any year of the proposed project. Annual

    continuation awards will depend on the availability of funds, grantee progress in meeting project goals and objectives, and timely submission of required data and reports.

2. FUNDING MECHANISM

Awards will be made as grants.

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

Eligible applicants are domestic public and private nonprofit entities. For example, State and

    local governments; federally recognized tribes; State recognized tribes, urban Indian organizations (as defined in P.L. 94-437, as amended); public or private universities and colleges; community- and faith-based organizations; and tribal organizations may apply. The statutory authority for this program prohibits grants to for-profit organizations.

    Consortia comprised of various types of eligible organizations are permitted; however, a single organization representing the consortium must be the applicant, the recipient of any award, and the entity responsible for satisfying the grant requirements.

    All applicants, including single organizations and consortia, must clearly indicate in their project narrative (in Section C, Management and Organizational Capacity whether they are a Recovery Community Organization (RCO) or Facilitating Organization (FO). If your

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    application fails to declare which type of organization you are, the Peer Review Committee will categorize your organization. Also, if the Peer Review Committee does not agree with the way you have categorized your organization, they may change your designation (e.g., from RCO to FO or vice versa).

    RCSP grantees in the 2001 cohort (whose current awards are ending September 29, 2006) may apply for this program. RCSP grantees in the 2003 and 2004 cohorts are ineligible for this program.

2. COST-SHARING

    Cost-sharing is not required in this program, and applications will not be screened out on the basis of cost-sharing.

3. OTHER

3.1 Additional Eligibility Requirements

    Applicants must comply with the following requirements, or they will be screened out and will not be reviewed: use of the PHS 5161-1 application; application submission requirements in Section IV-3 of this document; and formatting requirements provided in Section IV-2.3 of this document.

3.2 Evidence of Experience

    SAMHSA believes that only existing experienced organizations with demonstrated infrastructure and expertise will be able to provide required services quickly and effectively. Therefore, in addition to the basic eligibility requirements specified in this announcement, applicants must meet the following additional requirement related to the provision of services:

    ; Each applicant organization must have at least 2 years experience (as of the due date of

    the application) providing peer recovery support services or some other relevant

    services or activities in the geographic area(s) covered by the application.

In Appendix 1 of the application, you must include the Statement of Assurance (provided in

    Appendix J of this announcement), signed by the authorized representative of the applicant organization identified on the face page of the application, that the applicant organization meets the 2-year experience requirement.

In addition, if, following application review, an application’s score is within the fundable range

    for a grant award, the Government Project Officer (GPO) will call the applicant and request that the following documentation be sent by overnight mail:

    ; Official documentation that the applicant organization has been providing relevant

    services for a minimum of 2 years before the date of the application in the area(s) in

    which the services are to be provided. Official documentation can be a copy of the

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