SUBSTANCE ABUSE AND MENTAL HEALTH
SERVICES ADMINISTRATION

II. METHODOLOGY

• Funding for Program Management activities is considered drug-related to the extent that funds are used to support the operations of the Center for Substance Abuse Treatment (CSAT), the Center for Substance Abuse Prevention (CSAP), and the activities of the Office of Applied Studies (OAS) that are supported by Set-aside funds from the Substance Abuse Prevention and Treatment Block Grant/Performance Partnership Grant (SABG/PPG).



• Funding for Substance Abuse Prevention and Treatment Knowledge Development and Application (KDA) activities is considered 100 percent drug-related, funding for OAS Data Collection Activities is considered 100 percent drug-related. 



• Funding for the SABG/PPG is considered drug-related to the extent that these funds are used by the States/Territories for treatment and prevention of the use of illegal drugs and used by the Agency for technical assistance, data collection, and program evaluation.



• Five percent of the Block Grant is required to be used for the SAMHSA set-aside activities which support data collection, technical assistance, the National Data Center, and program evaluation. The remaining 95 percent is distributed to the States and Territories where at least: 35 percent must be used for alcohol prevention and treatment activities; 35 percent must be used for other drug prevention and treatment activities; and, the remaining 30 percent is to be used at State discretion. For budget formulation purposes, SAMHSA scores the discretionary amount equally for alcohol and drugs, with 15 percent assigned to alcohol programs and 15 percent assigned to drug programs. The block grant supplement of $50 million provided by P.L. 104-121 is scored 100 percent for treatment of alcohol and drug abuse. 

III. PROGRAM SUMMARY

Goal 1: Educate and enable America's youth to reject illegal drugs as well as alcohol and tobacco.

• Financial support for this goal includes funding for the Prevention Knowledge Development and Application program (KDA), 20 percent of the Substance Abuse Prevention and Treatment Block Grant/PPG, as well as program support for these activities.



• Funding for Prevention KDA's includes continuation of pre-1996 demonstration awards including funding for the Community Prevention Program (Systems Partnerships and Service Partnerships, High Risk Youth Program (Public Housing, School Based, Violence, Adolescent Women), Public Education Activities (Communications, Conferences) and Training Programs.



• The remainder of the Prevention KDA portfolio includes knowledge development and application activities in the areas of Managed Care, Early Childhood Problems, Improving Community Services, Changing Systems and Practices, and Standards and Guidance.



• A key activity funded with the KDA for changing systems and practices is the new Youth Prevention Initiative which includes funding for State Incentive Grants, Regional Centers for the Application of Prevention Technologies, and a Media/Public Education Campaign in response to the increase in drug use among youth.



• Block Grant/PPG activities include State expenditures of a minimum of 20 percent of their block grant/PPG allotment for primary prevention as well as CSAP expenditures of 20 percent of the block grant/PPG set-aside for the development of State data systems (including the development and maintenance of baseline data on incidence and prevalence as well as the development and implementation of outcome measures on the effectiveness of prevention programs), provision of technical assistance (including the administration of the regulations implementing the Synar amendment on the use of tobacco by youth), and program evaluations.

Goal 3: Reduce health and social costs to the public resulting from illegal drug use.

• Financial support for this goal includes funding for the Treatment Knowledge Development and Application program (KDA), workplace programs (administered by CSAP), 80 percent of the Substance Abuse Prevention and Treatment Block Grant/PPG, as well as program support for these activities.



• Funding for Treatment KDA's includes continuation of pre-1996 demonstration awards including funding for the Target Cities program, Women and Children programs (Pregnant and Postpartum Women, Residential Treatment for Women and Children), Criminal Justice programs (adult, juvenile, institutional, community based), Critical Population programs, AIDS program (Linkage, Outreach), and training programs.



• The remainder of the Treatment KDA portfolio includes knowledge development and application activities in the areas of Managed Care, Early Childhood Problems, Improving Community Services, Changing Systems and Practices, and Standards and Guidance. Block Grant/PPG activities include State expenditures of 80% of their block grant/PPG allotment for treatment services as well as CSAT and OAS expenditures of 80% of the block grant/PPG set-aside for the collection and analysis of national data, the development of State data systems (including the development and maintenance of baseline data on the incidence and prevalence as well as the development of outcome measures on the effectiveness of treatment programs), provision of technical assistance, and program evaluations.



• Data collection activities will include funding to expand the National Household Drug Abuse Survey to include State specific surveys as part of the Secretary's Youth Prevention Initiative.

IV. BUDGET SUMMARY

1997 Base Program

• The FY 1997 base program provides a total of $311.7 million for substance abuse prevention and treatment Knowledge Development and Application (KDA) programs. KDA funding will support prevention and treatment initiatives in the following strategic areas: Managed Care; Early Childhood Problems/Working Families; Emerging Issues; Co-Occurring Disorders; Changing Systems and Practices; and, Standards and Guidelines. This includes funding for a substance abuse prevention youth initiative and a substance abuse treatment youth initiative to implement critically needed action to address the increasing use of illicit substances by our Nation's youth.



• The Substance Abuse Prevention and Treatment Block Grant/Performance Partnership Grant is $966.0 million. The passage of Public Law 104-121 adds an additional $50 million dollars to the SABG/PPG funding level for FY 1997 and FY 1998, to be used for "treatment of the abuse of alcohol and other drugs."



• SAMHSA will continue working with the States on the incidence and prevalence of substance abuse and dependence, access to appropriate prevention and treatment programs, the effectiveness of such programs, and the community and personal health risks of substance abuse. Negotiated performance objectives and indicators will provide States greater latitude in directing resources to meet local needs as well as ensuring that State and Federal needs are met with regard to substance abuse treatment and prevention.

• The total FY 1998 drug control budget request is $1,329.9 billion, a net increase of $30.4 million over the FY 1997 enacted level, including $379 million for Goal 1 and $951 million for Goal 3.

Knowledge Development and Application. The FY 1998 KDA program includes activities in three Development activities of Managed Care, Early Childhood Problems/Working Families, and Improving Community Services, and two Application activities for Changing Systems and Practices and Standards and Guidelines. A total of $179.0 million is requested for Goal 1 KDA drug-related activities.

• The focus of SAMHSA's activities in FY 1998 is to expand the comprehensive Youth Substance Abuse Initiative. CSAP will begin a regional approach to provide prevention knowledge and technical assistance for implementing effective programs, strategies, and policies, and opportunity for skills enhancement to ensure effective application of the latest knowledge; a major mass media and education campaign; and, State Incentive Grants, which will aid local governments in implementing Goal One of the Strategy.



• CSAP is examining the impacts of different managed care models on use, cost, and outcomes of persons with substance abuse. Common protocols for data collection are being developed in support of ONDCP objectives.



• Funding is requested to continue and expand the Starting Early/Starting Smart initiative. This initiative is a collaborative, multi-site approach utilized to test the effectiveness of integrating mental health and substance abuse treatment services (behavior health services) into either the primary care or early childhood service settings, and to synthesize the results of this knowledge development effort. This initiative will be expanded to include additional target populations and cultural groups.



• The FY 1998 request expands and extends the Geographic Information System (GIS) initiatives to facilitate community, county, and state level needs assessment, resource allocation and tracking, and projection of future substance abuse and mental illness resource needs.

• The FY 1998 formula will be updated to reflect more recent demographic statistics resulting in a reallocation of resources among the States. Legislation will be submitted to: increase State flexibility by waiving certain requirements in exchange for performance; and, strengthen State performance data infrastructure by working with States to identify and test performance and outcome indicators.



• Resources from the Block Grant/PPG 5 percent set-aside will be used for State data systems, technical assistance, and program evaluation activities. Set-aside activities include Prevention Minimum Data Sets (including outcome measures), Synar Amendment and Prevention Enhancement Protocols.

Goal 3: Reduce health and social costs to the public of illegal drug use.

• The drug control request for Goal 3 activities for FY 1998 is $951 million, a net increase of $6 million over FY 1997. The 1998 request includes the KDA activities which develop state and regional networks for the exchange of information on what works in treatment and what is still needed. 

Knowledge Development and Application. A total of $156.0 million is requested for Goal 3 KDA drug-related activities.

• The focus of SAMHSA's activity in FY 1998 is to expand the comprehensive Youth Substance Abuse Initiative. This initiative is consistent with reducing youth substance abuse and Goal 3 of the National Drug Control Strategy. CSAT will begin a regional approach to provide prevention and treatment knowledge and technical assistance for implementing effective programs, strategies, and policies, and opportunity for skills enhancement to ensure effective application of the latest knowledge. CSAT will develop data systems to measure the impact and outcome of treatment and disseminate information to the community.



• In 1998, CSAT's effort will address high risk youth, truancy, and juvenile assessment and treatment. Another venture will address co-morbidity of substance abuse and mental health disorders in adolescents. Additionally, CSAT will fund a program to evaluate the effectiveness of a variety of interventions and treatment for adolescents meeting the criteria for marijuana dependence and examine the effects of methamphetamine use.



• SAMHSA is examining the impacts of different managed care models on use, cost, and outcomes of persons with substance abuse and mental disorders, and the connection between substance abuse and mental disorders. Common protocols for data collection are being developed in support of Goal 3. Additionally, CSAT will address the following issues: Emergency Room treatment linking to depression and alcohol and drug abuse; the Homelessness Prevention program; and prevention, intervention and treatment for at-risk or HIV positive individuals. CSAT will develop a private-public partnership for accreditation of an opiate treatment program. Accreditation will be used to determine the basis for certifying opiate treatment programs.

Substance Abuse Block Grant/PPG. A total of $973 million is requested for this program, of which an estimated $785 million is for state substance abuse treatment activities (including alcohol).

• The FY 1998 formula will be updated to reflect more recent demographic statistics resulting in a reallocation of resources among the States.



• Legislation will be submitted to: increase State flexibility by waiving certain requirements in exchange for performance; and strengthen State performance data infrastructure by working with States to identify and test performance and outcome indicators. Resources from the Block Grant/PPG 5% set-aside will be used for State data systems as well as for national data collection, technical assistance, and program evaluation activities. Set-aside activities include State Needs Assessments, State Treatment Outcome Pilots, National Drug Abuse Household Survey, DAWN survey, and the development of Treatment Improvement Protocols.

V. PROGRAM STATISTICS

VI. PROGRAM ACCOMPLISHMENTS

• SAMHSA has been and will continue to participate in ongoing discussions with the field and the states on performance measures and how these measures impact state funding decisions. These discussions are linked to SAMHSA/CSAP technical assistance activities financed in the block grant-set aside to develop prevention enhancement protocols (PEPS) along with outcome measure pilots and prepare the states for the implementation of GPRA in 1999. Through block grant set-aside funds, SAMHSA/CSAP is also supporting a minimum data set project with the states which is designed to determine the efficacy of collecting, analyzing, and disseminating uniform process data (Phase 1) and uniform outcome data (Phase II) by state and across states. Phase I is currently being pilot tested in the initial twelve states, phase II funding is included within FY 1998 block grant request.



• The Youth Initiative, which includes a component for a media campaign conducted in coordination with ONDCP, would convey the negative consequences of illicit drug use, including marijuana and methamphetamine. Several of the goals of the initiative have already been met. For example, in 1996 a report was produced which guides agencies in developing media campaigns. Further, in late 1996, several contracts were written to explore the current status of knowledge and 1) effectiveness of current treatment for methamphetamine dependence; 2) effects of methamphetamine use by pregnant women on the development of the fetus and subsequent childhood adjustment.



• Results from the work on use during pregnancy led to records on methamphetamine use during pregnancy from 1989 to present.



• Presented data from the National Treatment Improvement Evaluation Study (NTIES) on 6,000 patients that demonstrated the validity of self-report about drug use by comparing self-report to monitored urine samples and clinic records the NTIES study pioneered the use of direct computer entry of interview data which is likely to become the standard for the field.



• Developed a cost-accounting methodology that can be used by administrators or evaluators of any program to determine the costs of any element of treatment. Further, SAMHSA has compared studies of treatment outcome by states using data bases dealing with objective measures of social functioning and cost to the public such as hospital admissions, job-related income, welfare benefits, costs billed to the state for medical treatment and interactions with the criminal justice system.