[Federal Register Volume 60, Number 35 (Wednesday, February 22, 1995)]
[Notices]
[Pages 9853-9855]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-4322]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Cooperative Agreement with the Pennsylvania Department of Health

AGENCY: Center For Substance Abuse Treatment, Substance Abuse and 
Mental Health Services Administration (SAMHSA), HHS.

ACTION: Notice of a planned single source, cooperative agreement award 
to support further development and continuation of a model 
comprehensive substance abuse treatment demonstration program for the 
City of Philadelphia.

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SUMMARY: The Center for Substance Abuse Treatment (CSAT), SAMHSA, is 
publishing this notice to provide information to the public regarding a 
planned single source competing continuation award to the Pennsylvania 
Department of Health for the further development and operation of a 
model substance abuse treatment demonstration program. The current 
``Target Cities'' project period will be [[Page 9854]] extended for an 
additional two years. The first year of the new cycle funding, fourth 
year of operation, will be funded with approximately $2,500,000 in 
federal funds. This is not a request for applications. The cooperative 
agreement will be awarded to the Pennsylvania Department of Health only 
upon receipt of a satisfactory application which is recommended for 
approval by an initial review committee and the CSAT National Advisory 
Council.

AUTHORITY/JUSTIFICATION: The competing continuation award will be made 
under the authority of Section 510(b)(5) of the Public Health Service 
Act, as amended (42 U.S.C. 290bb-3).
    An award is being made on a single source basis in response to the 
Senate Committee on Appropriations report 103-318, accompanying HR 
4606, which has language that states: ``Sufficient funding has been 
provided for CSAT to conduct an application cycle in fiscal year 1995 
to extend from 3 to 5 years funding for the target cities grantee that 
was funded out of the normal funding cycle in fiscal year 1991.'' The 
report further states: ``The Committee expects the Center will maintain 
an application criteria that is consistent with and that meets the 
review standards and other requirements subject to target city 
applicants in fiscal year 1993.''

BACKGROUND: In fiscal year (FY) 1990, the Office for Treatment 
Improvement (CSAT's predecessor agency) initiated the Target Cities 
Cooperative Agreement Demonstration Program to assist major 
metropolitan areas with linking, integrating, and enhancing the 
components of their addiction treatment and health and human service 
systems in order to overcome the problems described below. In 1990, 
eight target cities were funded for a three-year period. On June 1, 
1992 a ninth target city was funded in Philadelphia, Pennsylvania. In 
1993 a review cycle for target cities applications was conducted by 
CSAT. In addition to new applications, each of the original eight 
cities was given an opportunity to compete for a fourth and fifth year 
of continuation funding. Because the Philadelphia target city was in 
its second year of implementation, it was not eligible in 1993 to 
compete for a fourth and fifth year of funding. In order to address 
this lack of opportunity, and in response to the Senate Committee on 
Appropriations report 103-318, referenced above, a competing 
continuation application is being requested from the State of 
Pennsylvania for the Philadelphia target city based on the guidelines 
provided in the 1993 Program Announcement No. AS 93-07.
    Many areas of the United States could benefit from additional 
financial aid designed to improve access to high quality, effective 
addiction treatment and recovery programs and related health and human 
services. Some cities are facing demand for these resources in crisis 
proportions.
    Epidemiological data indicate that individuals who live near or 
below the poverty line in large metropolitan areas tend to exhibit a 
high prevalence of alcohol and drug use and a concomitantly high 
incidence of addiction-related medical, psychological and socio-
economic problems. Escalating incidence rates for HIV/AIDS, 
tuberculosis and sexually transmitted diseases in the metropolitan 
areas are closely linked to alcohol and drug use, as are homelessness, 
unemployment, crime and violence.
    In most metropolitan communities, multiple factors have combined 
over time to diversify and fragment the components of the health and 
human services system rather than to integrate and facilitate the 
provisions of services and case processing alternatives for those who 
suffer from alcohol and drug problems. In almost all cases, 
jurisdictions with high demand for addiction treatment and recovery 
services have lacked sufficient resources for the enhancement or 
expansion of diagnostic, coordinated case management and evaluation 
efforts necessary to improve the effectiveness of the services 
infrastructure. Of great concern from a public health perspective, is 
that many addiction treatment and recovery programs do not have the 
resources or appropriate linkages with health care facilities to ensure 
that individuals with addictive disorders and their sexual partners are 
screened and treated for HIV, tuberculosis, and other infectious 
diseases.
    In the context of complex and fragmented metropolitan systems of 
health and human service delivery, it is not likely that the needs of 
alcohol and drug-involved individuals and their families who live near 
or below the poverty line will be addressed in a cost-effective manner, 
for one or more of the following reasons:
    (1) The system is not capable of concisely and comprehensively 
assessing individual and family needs.
    (2) The existing infrastructure is designed to provide 
interventions on a discrete basis rather than to address the bio-
psycho-socio-economic needs of the individual and family as part of a 
coordinated continuum.
    (3) Individuals with alcohol and drug problems and their 
collaterals are not capable of effectively negotiating the complexities 
of a system composed of discrete, uncoordinated programs and are often 
unable to locate the treatment program(s) that best suits their needs.
    (4) Individuals may be turned away from programs that lack the 
capacity to provide needed assistance, and may be unaware that there 
are other treatment alternatives available within or adjacent to the 
community in which they live.
    (5) Individuals may be admitted to programs that are not capable of 
addressing their unique needs or are not designed to provide services 
in a cost-effective manner.
    (6) Services may be delivered in a manner that is inconsistent with 
the current racial, ethnic, cultural, socio-economic and practical 
realities of the individuals and families who request assistance.
    Since June 1992, the Philadelphia Target City Project has addressed 
many of the problems discussed above by directly enhancing the public 
drug and alcohol service system through eight inter-related components. 
These components are a central intake unit, a management information 
system, an enhanced case management system, provider staff 
enhancements, training and staff development, project evaluation, and 
two special initiatives. The special initiatives include a Labor 
Initiative component that is implemented through the Department of 
Labor's Job Training Partnership Act, and a CSAT Criminal Justice 
Initiative. The Labor Initiative provides vocational assessment, 
training and employment opportunities to individuals that have 
successfully completed treatment. The Criminal Justice Initiative 
provided funds for the development and implementation of a criminal 
justice management information system (MIS). This MIS has coordinated 
services and provided for the tracking of individuals through the 
Philadelphia treatment and criminal justice systems. The criminal 
justice MIS has provided for an effective system of early release from 
criminal justice institutions to treatment providers. These components 
provide patients access to treatment, standardized assessment, and 
appropriate referrals to an enhanced, integrated, and comprehensive 
treatment, medical and social service system. During the period of 
project implementation 4,000 individuals have been assessed for 
treatment services and 2,300 admissions to treatment have been 
accomplished. This single source award is planned to continue the 
development and implementation of a project that has 
[[Page 9855]] successfully improved and enhanced substance abuse 
treatment services for individuals receiving care through the publicly 
funded treatment system in Philadelphia.

FOR FURTHER INFORMATION CONTRACT: Randolph Muck, Acting Chief, Systems 
Improvement Branch CSAT/SAMHSA, Rockwall II, Room 618, 5600 Fishers 
Lane, Rockville, MD. 20857. Telephone: (301) 443-8802.

    Dated: February 16, 1995.
Richard Kopanda,
Acting Executive Officer, SAMHSA.
[FR Doc. 95-4322 Filed 2-21-95; 8:45 am]
BILLING CODE 4162-20-P