Transformation Transfer Initiative

In a continued effort to assist states in transforming their mental health systems of care the Substance Abuse and Mental Health Services Administration (SAMHSA) and its Center for Mental Health Services (CMHS) has created the Transformation Transfer Initiative (TTI). The TTI provides, on a competitive basis, modest funding awards to States, the District of Columbia, and the Territories not currently participating in the Mental Health Transformation State Incentive Grant* (T-SIG) program. To view the

These flexible TTI funds are to be used to identify, adopt, and strengthen transformation initiatives and activities that can be implemented in the State, either through a new initiative or expansion of one already underway, and should focus on one or multiple phases of system change. TTI recipients are chosen on the following criteria:

  • Transformation readiness, demonstrated by examples of transformation initiatives already underway using State funds, Block grant funds, other identified public or private resources;
  • Existing multi-agency collaboration on transformation initiatives;
  • Proposed initiatives rooted in systems change with the greatest quality impact;
  • Identification of other state resources and infrastructure which may leverage the TTI award funds for the proposed initiative; and
  • Realistic timeframes, concrete activities, and measurable outcomes for the proposed initiative.

In FY 2019-2020, CMHS awarded TTI grants to the following twenty states & territories:

  • American Samoa - Will serve individuals with an SMI diagnosis by providing incentives of transportation and prepared meals for attending mental health treatment sessions. Will also cover all medication costs through Medicaid or program funding. Plans to setup telehealth services to allow for face-to-face services.

  • District of Columbia - Will serve individuals with SMI during their transition from correctional facilities to the community using incentives by collaborating with community service providers and certified Peer Supports.

  • Delaware - Will continue the overall system transformation and expand the capacity built by the bed registry system initiated by TTI 2019 through leveraging technology and these funds to improve the continuum of care following the treatment and referral system. To improve engagement rates with these referrals, will provide direct incentives for individuals with SMI when transitioning between levels of care, particularly inpatient to outpatient behavioral health settings. Will continue looking for ways to support telehealth across the system.

  • Florida - Will establish incentives to improve outpatient engagement of youth and families engaged in the child welfare system due to mental health or dual diagnosis concerns in a targeted area of the state to integrate child welfare and behavioral health services. Focuses on populations that suffers from untreated trauma and generational abuse or neglect. Will provide family navigators for those who need additional support and/or have not previously availed themselves of services and has increased focus on telehealth services.

  • Georgia - Will partner with service providers to reduce no-show rates and improve early engagement in treatment through an incentive system (NICE!) for individuals with SMI. A community navigator or peer support specialist will be available.  Will prioritize data collection and conduct further data analysis through a case control study to evaluate effectiveness of incentives.

  • Guam - Will serve young adults experiencing FEP and/or SMI/SED transitioning from psychiatric inpatient services, corrections/jails, and homeless shelters, to outpatient services by providing vouchers/incentives prior and/or after appointments. Peer navigators will be assigned to participants.

  • Kansas - Will adopt a two-pronged approach to provide wellness recovery related activities and incentives to assist consumers with SMI in recovery-oriented activities to increase engagement in first and subsequent appointments, as well as staff incentives to combat staff retention challenges. Focus on coordination and collaboration between the hospitals, case managers, and peer supports to provide wrap-around services.

  • Kentucky - Will expand upon existing continuity of care efforts through the addition of contingency management (CM) and evaluation of the impact of this intervention through the Kentucky Incentives for Improving Outpatient Engagement Project (KIP). Will implement a CM intervention for individuals with SMI discharged from a state hospital using a voucher-based system to incentivize care compliance. Peer support services will be available. As a point of comparison, of the four Community Mental Health Centers serving the region, two will continue treatment as usual (i.e. without incentives).

  • Massachusetts - Will first support individuals at risk of losing their housing because of hoarding issues through peer specialists and supermarket gift card incentives due to adjustments from COVID-19. Then, will increase engagement among older adults with SMI in outpatient care following discharge from a geriatric psychiatry specialty unit. Massachusetts is developing the Certified Older Adult Peer Specialist (COAPS) Workforce to support this population and is involving the Area Agency of Aging/Aging Services Access Points to reach out to older adults with SMI served through homecare and through Protective Services.

  • Mississippi - Will serve adults who have been court committed to a state hospital for acute psychiatric care in their transition to a local community mental health center. Following a warm handoff, peer Bridgers will support these individuals, and incentives will be offered as vouchers for attending follow-up appointments. A recent virtual peer support training will allow for more certified Peer Bridgers. Interested in collecting data to determine the impact of incentives for possible expansion of the program statewide.

  • Missouri - Will serve children and their families with co-occurring diagnoses of SED and I/DD by providing vouchers to assist with treatment costs and to serve as incentives. With the goal of implementing best practices for this population, will create a mobile application and an Extension for Community Health Care Outcomes (ECHO), with the goal of assisting clinical professionals in utilizing trauma-informed clinical best practices. 

  • Nevada - Will serve uninsured or under-insured individuals placed on a civil commitment hold and in need of psychiatric treatment by providing a token economy system of incentives to increase patient compliance for follow up appointments after discharge from an acute psychiatric hospital. Utilized occupational therapy to support clients with leisure activities and public health education. Will increase telehealth for urban clinics and case management.

  • New Jersey - Will serve hospitalized patients who have had difficulties being discharged from or are “at risk” of entering institutional care post-discharge by integrating Recovery-Oriented Cognitive Therapy (CT-R) and incentives, along with increased peer support. Added a colleague who specializes in co-occurring & substance use disorder to the team to offer guidance for effective incentives.

  • New York - Will improve Sustained Engagement Support Team (SES) by adding Peer Bridgers and incentives to increase initial and sustained engagement for those transitioning from an inpatient hospital, jail or prison setting. Clients have traditionally not availed themselves of services or who lose contact with service providers. Is using telehealth throughout its outpatient programs.

  • North Carolina - Will serve individuals with mental illness after use of behavioral health crisis services by offering gift cards as incentives for attending follow-up appointments. Will incentivize engagement in the RICCM (Resource Intensive Comprehensive Case Management) service, which has proved to be very effective, when individuals initially refuse to engage in the program, and then incentivize the subsequent four visits after agreeing. Participants will have access to a Certified Peer Support Specialist. Peers attended a webinar on digital peer support, and the majority of adult mental health services provided services via telehealth.

  • Oklahoma - Will serve individuals with SMI leaving higher levels of care or at great risk of going into higher levels of care by adding an incentives program to outreach and engagement efforts, such as bus passes, clothing, tents, and food. Hired dedicated staff to expand outreach efforts and provide needed services and resources. Focus on improving continuum of care and warm handoffs through Street Outreach and Rapid Response team to connect with clients who traditionally have not availed themselves of services or have frequently been in contact with hospitals and crisis centers without attending follow-up appointments.

  • Puerto Rico - Will serve individuals discharged from collaborating organizations by establishing incentives in the form of vouchers to improve outpatient engagement greater autonomy until reintegration and independence are achieved in the community. Focus on individuals experiencing FEP to improve outpatient engagement. Have worked with partners on implementing tele-mental health, and peer specialists have run support groups throughout the crisis using virtual and phone communication.

  • South Carolina - Will serve patients with high needs and/or issues accessing care such as those recently: incarcerated, leaving psychiatric hospitals, receiving mobile crisis services or youth, or young adults and their families in FEP initiatives. Will increase patient engagement through incentivizing therapy session attendance, providing transportation services, adding automated and mobile patient outreach, and utilizing peer support specialists.

  • Utah - Will serve youth and young adults with SMI or FEP, and/or experiencing homelessness through incentives in the form of vouchers. Families will also be eligible for incentives, and Service Navigators will provide additional supports. The Utah Navajo Healthcare System is included as an incentive site and will help gather data on the impact of incentives for Native Americans.

  • Vermont - Will serve individuals experiencing homelessness and with a mental illness and/or co-occurring substance use disorder at risk of entering, or currently leaving, institutional care, particularly those who have not previously availed themselves of services. Will utilize stipends to improve outreach efforts, success rates, and continuity of care for this population.


In FY 2018-2019, CMS awarded TTI grants to the following twenty-three states:

  • Alabama – Will develop an inpatient services need methodology to identify the number of inpatient psychiatric beds needed to ensure quality inpatient psychiatric care.
  • Connecticut – Will develop a psychiatric bed registry based off an existing state substance abuse services registry, and will partner with the University of Connecticut School of Social Work to evaluate. 
  • Delaware – Will expand their existing Delaware Treatment and Referral Network to include additional peer support services and other social services, and integrate vulnerable populations into the existing system.
  • Florida – Will convert their existing registry into a centralized, web-enabled platform which will enable real-time registry of psychiatric and acute care beds that are vacant and occupied statewide.
  • Georgia – Will integrate three separate, existing bed boards into one single unit, and will create an automated screening process for medical clearance and a secure interface for external partners to communicate on crisis admissions.  
  • Idaho – Will develop a statewide psychiatric bed registry and facilitate the use of the portal across community mental health agencies, crisis centers, jails, community hospitals, and state hospitals statewide.
  • Indiana – Will expand the existing substance use disorder registry with a psychiatric bed registry for twenty private inpatient sites throughout Indiana.
  • Maryland – Will expand an existing bed registry in Anne Arundel County registry statewide, and will include substance use disorder and mental health treatment providers in the registry.
  • Massachusetts – Will expand the existing registry by adding a registry of outpatient providers that offer open access appointments and adding a registry of medication-assisted treatment providers in the state.
  • Mississippi – Will develop a statewide web-based bed registry incorporating inpatient psychiatric beds in state hospitals, crisis stabilization units, and crisis respite services.
  • Nebraska – Will partner with Region 6 to pilot a bed registry to track acute psychiatric hospital beds for youth and adults in the region.
  • Nevada – Will develop an online real-time bed registry designed to adequately assess, treat, ensure rapid placement at appropriate levels of care, and facilitate transitions of care across the continuum for individuals with SMI and SED.
  • New Jersey – Will establish a psychiatric bed registry of short term psychiatric and crisis respite beds statewide, and expand the existing Bed Enrollment Data System, which tracks community-based housing.
  • New Mexico – Will fund and establish a substance abuse bed registry, including administration, monitoring, data collecting, and training.
  • New York – Will hire staff to assist current OMH staff assigned to their already-established bed registry system, and will train hospital staff.
  • North Carolina – Will expand and improve their existing bed registry system, including improving the existing referral and search features, adding a secure messaging feature, and expanding the use of the system to include transportation for individuals.
  • Ohio – Will establish a psychiatric bed registry, based off an already established registry in one Ohio county, with the capacity to add community-based crisis resources in one region of the state.
  • Oklahoma – Will expand their current database to include inpatient psychiatric beds for children in need of acute care.
  • Rhode Island – Will establish a bed registry which will provide real-time data on bed availability.
  • Tennessee – Will update their existing registry to become a real-time psychiatric bed availability system, with the ultimate goal of including information specific to crisis and substance abuse disorder services.
  • Utah – Will create an electronic bed registry system which will track the availability of mental health inpatient beds, substance use treatment beds, detox bed, outpatient beds, and social resources.
  • Vermont – Will perform an evaluation of their existing electronic bed registry system and will either perform maintenance, update, or replace the current system based on their findings.
  • West Virginia – Will develop a statewide crisis line and psychiatric bed registry connecting resources available to children experiencing serious emotional disturbance into a single database.


In FY 2017-2018, CMHS awarded TTI grants, all in the amount of $220,000, to the following six states: 

  • Georgia – They targeted specific groups of providers that we had not yet trained as well as expanded the capacity of staff certified in CT-R. Find Georgia Summary Here. 
  • Massachusetts – They partnerned with The Bridge of Central MA, Inc. to develop in-state capacity for the CT-R trainers to expand delivery of this evidence-based practice within the community-based service delivery system for people with severe mental illness. Find Massachusetts Summary Here.
  • Montana – They enhanced the skill set of MSH and community staff at various levels of training and experience, improved outcomes of individuals with serious mental illness, while additionally promoted and improved continuity of care. Find Montana Summary Here. 
  • New Jersey – They focused on health integration and culminated into the hosting of a CT-R consumer outcome Summit as well as the development of a Behavioral Health Home Toolkit featuring the integration of CT-R in integrated settings, as well as peer-delivered CT-R within clinical teams. Find New Jersey Summary Here. 
  • New York – They expanded the use and availability of CT-R provided to individuals with serious mental illness to assist their transition from inpatient hospitalization and improve their community tenure. Find New York Summary Here. 
  • Vermont – They strengthened the promotion of recovery by implementing and sustaining Recovery-Oriented Cognitive Therapy (CT-R) strategies for adults with serious mental illness (SMI) enrolled in Community Mental Health Centers (CMHC) initially in four regions of the state and eventually statewide. Find Vermont Summary Here. 

In FY 2016-2017, CMHS awarded TTI grants, all in the amount of $221,000, to the following six states: 


In FY 2015-2016, CMHS awarded TTI grants, all in the amount of $221,000, to the following two states: 

  • Illinois - Expanding statewide Warm Line using a smartphone app to connect with homeless youth.
  • New York – Improving statewide clinical data infrastructure to support a newly developing Behavioral Health Crisis Intervention System.


In FY 2014-2015, CMHS awarded TTI grants, all in the amount of $221,000, to the following six states: 

  • Idaho – Developing 3 Specialty CPS Certifications: 1) Crisis Intervention 2) Forensic 3) Co-Occurring
  • Kentucky – Young Adult Peer to Peer Crisis Support Services
  • Missouri – Linking Peer Services to the Traditional Crisis Intervention System 
  • New Jersey – Developing Curricula and Training Forensic Peer Bridgers
  • Pennsylvania – Training and Using CPSs in Behavioral Health Crisis Services
  • Tennessee – Placing Peer Bridgers into Crisis Stabilization Units 


In FY 2013-2014, CMHS awarded TTI grants, all in the amount of $221,000 to the following five states: 

  • Michigan – Self-Directed Care in Behavioral Health
  • New York – Self Directed Care for individuals with serious mental illness 
  • Pennsylvania – expanding its current Self-Directed Care (SDC) project in Delaware County
  • Texas – Sustainable Self Directed Care program for possible participation in a multisite evaluation of the model. 
  • Utah – Self-directed care service within Medicaid

Summaries of FY 2013-2014 Projects:



In FY 2012-13, CMHS awarded TTI grants, all in the amount of $221,000, to the following eleven states:

  • Guam - Self-Directed Care, Mental Health First Aid, Suicide and Trauma Informed Care
  • Idaho - Statewide Recovery Infrastructure and Empowerment (MH & SA)
  • Illinois - Creating an Integrated Database for Mental Health, Drug and Veterans' Courts
  • Indiana - Behavioral and Primary Health Integration
  • Kentucky - Expanding Access to Evidence-Based Practices for Kentucky’s Young Children in Child Care
  • Louisiana - Criminal Justice Collaborative Demonstration
  • Massachusetts - Building Capacity for Peer Support in Deaf Communities
  • Minnesota - Veteran Certified Peer Support and Specialists
  • Nebraska - Trauma Informed Peer Support within Family Systems
  • Tennessee - Expanding Screening and Referral to Community Services for Youth in Juvenile Courts
  • Virginia - Cross Systems Education and Statewide Advance Directives Project

Summaries of FY 2012-13 projects are located here