Repository – Expansion Grant Y2

SAMHSA Expansion Grant Year 2

(To “LINKS” Page)

Planning for Year 3 – Go to 

Year 2

Expansion Year 2 Continuation Application (Approved by SAMHSA) – If this pdf doesn’t load properly, request by email

     Budget Narrative – Y2

     Project Narrative – Y2

NoA Year 2

NoA Year 2 – Revised (with carryover)



    JCC Contract – Amendment 3 (To add Carryover)

    JCC Contract – Amendment 2

    JCC Contract (Original Contract for Year 2 is Amendment 1 to Year 1)


    Budget Amendment 2 (with carryover), 4-20-17(b), ($1,619,142)

    Budget Amendment 1, 2-1-17, ($1,050,000)



Year 2 SubContracts


Non-Federal Year 2 Match (Inkind) projected on Continuation Application

  • UF – PI  $30,244
  • MHA (Family / Youth)    $25,000
  • Lutheran Services Florida  $150,000
  • Baptist  $300,000.00
  • JCC  $98,749

Non-federal match requirements, Years 1 – 4

Year      Federal          match

  1.    $1,000,000           $333,333
  2.    $1,000,000           $333,333
  3.    $1,000,000           $333,333
  4.    $1,000,000       $1,000,000

Total   $4,000,000     $2,000,000


RFA – Part 1 – Part 2


Initial Application, Submitted 4/9/15

Completed Electronic Application (Pdf with all attachments uploaded)

Attachments that are uploaded to Application can be opened separately here:

PNF – Project Narrative File (Abstract, TOC and Project Narrative – Sections A – E)

Other Attachment File 1 (Bios, Job Descriptions and Confidentiality and SAMHSA Participant Protection/Human Subjects)

Other Attachment File 2 (Attachment 1: Letters of Commitment , Attachment 2: Data Collection Instruments/Interview Protocols, Attachment 3: Sample Consent Forms , Attachment 4: Letter to the SSA , Attachment 5: Non-Federal Funds Match Certification Letter , Attachment 6: Strategic Plan, Needs Assessment, or Priority Letter)

BNF – Budget Narrative File


Individual Documents Included in Other Attachment Files 1 and 2 above:

(Section F) Biographical Sketches and Job Descriptions 


PI, 0.1 FTE Jeff

PI  Jon Heymann

Program Director, 1 FTE, Vicki Waytowich

CLC Coordinator, 1 FTE, Selena Webster-Bass

Nurse Manager, 1 FTE, Stephanie Welch

Administrative Support, 1 FTE, Heather Castillo

Wraparound Coordinator, 1 FTE, Juliana Mickler

Pediatrician, 1 FTE, Rita

Contract Manager, .5 FTE, Edie Manning

F-Job Descriptions


Program Director

Marketing and Communications Coordinator

CLC Coordinator

Nurse Manager

Nurse Care Coordinator

Administrative Support

Wraparound Coordinator


Contract Manager 

Parent Partner

(Section G) Confidentiality and SAMHSA Participant Protection/Human Subjects

Longitudinal Consent – Caregiver Young Adult – stamped

Longitudinal Consent to Contact – stamped

Longitudinal Youth Assent – stamped

Descriptive Youth Assent – stamped

Descriptive Caregiver Young Adult Consent- stamped

Descriptive Protocol

Longitudinal Protocol

Confidentiality Policy 2015

Attachment 1: Letters of Commitment

State (DCF)




Attachment 2: Data Collection Instruments/Interview Protocols






WrapAround Cultural Assessment Guide

WrapAround client satisfaction surveys

Care Coordination intake / assessment forms

Care Coordination client satisfaction surveys

Attachment 3: Sample Consent Forms

WrapAround Authorization for Exchange of Information

WrapAround Authorization Consent

Care Coordination Consent Forms

Attachment 4: Letter to the SSA (Response-not uploaded to application)

Attachment 5:  Non-Federal Funds Match Certification Letter  (Funding Commitments – Not included with proposal)

Attachment 6:  Strategic Plan, Needs Assessment, or Priority Letter

Vision for the Future of Behavioral Health in Florida

LSFHS 2015 Strategic Plan

JSOCI Strategic Plan

Sustainability Plan

Charitable Choice Form – SMA 170 

Mailed as directed – Do not attach

HHS 690 Form


Key SAMHSA Links

RFA Announcement – Cooperative Agreements for Expansion and Sustainability of the Comprehensive Community Mental Health Services for Children with Serious Emotional Disturbances

Applying for a SAMSHA Grant

Webinar Link – 2015 System of Care Expansion and Sustainability Cooperative Agreements RFA Overview

Application Forms and Resources


HHS690  (does 2008 form on file fulfill requirement?)

Charitable Choice 

Assurances and Certifications



Additional Information for Completing Grant Application 

See Data, Outcomes, and Quality (DOQ) for information about substance use and mental health problems and trends at the state level and some smaller geopolitical areas.

Guidelines for Consumer and Family Participation will help applicant organizations promote consumer and family participation in grant programs.

Directory of Single State Substance Abuse Agencies (PDF | 185 KB)

Directory of Single State Mental Health Agencies (PDF | 31 KB)

Directory of Single State Substance Abuse Agencies (PDF | 185 KB)

Guide to Evidence-Based Practices will help you find websites with information about evidence-based practices to prevent and/or treat mental health and substance use disorders.

National Registry of Evidence-based Programs and Practices is a searchable online database of mental health and substance abuse interventions. Search it to find which may best meet your needs.

  • Match Requirement  (Federal : Non-Federal)
  • Year 1 – 3:1

    Year 2 – 3:1

    Year 3 – 3:1

    Year 4 – 1:1

    Matching resources may be in cash or in-kind, including facilities, equipment, or services and must be derived from non-federal sources (e.g., state or sub-state non-federal revenues, foundation grants). 

    There is concern that the federal funds for this program might be used to replace existing non-federal funds.  Therefore, applicants may only include as non-federal match, contributions in excess of the average amount of non-federal funds available to the applicant public entity over the 2 fiscal years preceding the fiscal year when the Federal award is made.  Non-federal public contributions, whether from State, county or city governments, must be dedicated to the community(ies) served by the cooperative agreement.

    Federal grant funds must be used for the new expenses of the program carried out by the grantee. That is, Federal grant funds must be used to supplement and not supplant any funds available for carrying out existing services and activities, (e.g., college suicide prevention activities).

    A letter from the director of the agency applying for the grant should certify that matching funds for the proposed initiative are available and are non-federal funds.  It is expected that non-federal match dollars will include contributions from various child-serving systems (e.g., education, child welfare, and juvenile justice).  You must specify the names of the expected sources, the types of sources (e.g., education, child welfare, and juvenile justice) and the amount of matching funds, to show evidence of your potential to sustain the system of care as you bring it to scale in your state/territory/tribe. The letter must be included in Attachment 5 of the application, Non-Federal Match Certification letter.  This letter should also indicate that proposed changes in funding streams required for the match or other funding innovations necessary for implementation of the proposed initiative will be allowed.  


Original SAMHSA RFA and Proposal (2010)


Proposal  –

Cover through page 5

Narrative, page 6 – 45

Literature Citations, page 46 – 54

Budget Justification, page 55 – 71

Biographical sketches and job descriptions, page 72 – 110

Confidentiality, Partic protect., etc page 111 – 117

Community Support, MOUs, page 118 – 136

Attachments 2- 6, page 137 – 166

Site Loc, Assurances, Lobbying, Checklist, page 167 – 180