Drug Abuse Treatment: Efforts Under Way to Determine Effectiveness of
State Programs (Letter Report, 02/15/2000, GAO/HEHS-00-50).
Pursuant to a congressional request, GAO reviewed the efforts by the
Substance Abuse and Mental Health Services Administration (SAMHSA) and
states to provide effective drug abuse treatment programs, focusing on:
(1) activities supported by SAMHSA's Substance Abuse Prevention and
Treatment (SAPT) block grant and Knowledge Development and Application
(KDA) grant funds for drug abuse treatment; (2) SAMHSA and state
mechanisms for monitoring fund use; and (3) SAMHSA and state efforts to
determine the effectiveness of drug abuse treatment supported with SAPT
block grant funds.
GAO noted that: (1) about $581 million in SAMHSA's fiscal year (FY) 1996
grant funds was spent on drug abuse treatment activities; (2) more than
$478 million was spent by all states for treatment services funded
through the SAPT block grant program; (3) the 16 states GAO surveyed
reported that SAPT funds supported both residential and outpatient drug
abuse treatment services, including detoxification and methadone
maintenance; (4) for half of the states in GAO's survey, outpatient drug
abuse treatment services accounted for 57 to 85 percent of their block
grant expenditures; (5) all of the states GAO surveyed reported
providing methadone treatment services almost exclusively on an
outpatient basis; (6) SAMHSA spent another $25 million of the SAPT block
grant for technical assistance and evaluation activities related to drug
abuse treatment; (7) the remaining $78 million of SAMHSA's FY 1996
grants were KDA funds provided to community-based organizations,
universities, and state and local government agencies to develop and
disseminate information on promising drug abuse treatment practices; (8)
to monitor grantees' use of SAPT and KDA program funds, SAMHSA uses
on-site reviews, reviews of independent financial audit reports, and
application reviews; (9) these mechanisms are primarily used to monitor
grantees' compliance with program requirements, identify grantees'
technical assistance needs, and provide grantees guidance for improving
program operations; (10) the accountability system for the SAPT block
grant is mostly based on a review of state expenditures; (11) SAMHSA
primarily monitors states' compliance with certain statutory
requirements for use of funds; (12) the states also monitor SAPT block
grant funds using mechanisms similar to SAMHSA's; (13) they used the
results of their monitoring efforts, in part, to make drug abuse
treatment funding allocation decisions and determine technical
assistance needs; (14) several state and SAMHSA efforts are under way to
determine the effectiveness of drug abuse treatment programs using
client outcome measures, such as drug use, employment, criminal activity
and living status; (15) nine of the 16 states that GAO surveyed have
conducted such assessments, but the results vary from state to state;
(16) SAMHSA officials believe that collecting uniform state-level client
outcome and other performance data are critical to determining the
effectiveness of state programs supported with SAPT block grant funds;
and (17) however, this effort is not likely to result in uniform state
data because some of the states reported that they would not be able to
submit all of the requested data.
--------------------------- Indexing Terms -----------------------------
REPORTNUM: HEHS-00-50
TITLE: Drug Abuse Treatment: Efforts Under Way to Determine
Effectiveness of State Programs
DATE: 02/15/2000
SUBJECT: Drug treatment
Grant monitoring
Drug abuse
Block grants
Federal/state relations
State-administered programs
Methadone maintenance
Reporting requirements
Discretionary grants
Funds management
IDENTIFIER: HHS Knowledge Development and Application Program
SAMHSA Substance Abuse Prevention and Treatment Block
Grant Program
SAMHSA State Treatment Needs Assessment Program
SAMHSA Services Research Outcome Study
SAMHSA Treatment Outcomes and Performance Pilot Studies
Enhancement Grant Program
SAMHSA National Treatment Improvement Evaluation Study
SAMHSA National Household Survey on Drug Abuse
SAMHSA Drug Abuse Warning Network
SAMHSA Drug Abuse Services Information System
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GAO/HEHS-00-50
Appendix I: Objectives, Scope, and Methodology
28
Appendix II: History and Administration of SAMHSA
30
Appendix III: KDA Grant Programs and Funding for Drug Abuse
Treatment
37
Appendix IV: State Program Assessments
40
Table 1: Characteristics of SAMHSA's Major Drug Abuse
Treatment Studies 20
Table 2: States' Client Outcome Assessment Activities 22
Table 3: SAMHSA's Administrative Expenses, Fiscal Year 1999 Appropriation 31
Table 4: Selected SAMHSA Contracts for Technical Assistance
and Program Evaluation, Fiscal Year 1999, by Agency and
Program 32
Table 5: SAMHSA's Staffing Levels by Program, as of
December 1999 35
Figure 1: Percentage of SAMHSA's Drug Abuse Treatment
Expenditures for SAPT Block Grant and KDA Grant Programs,
Fiscal Year 1996 9
Figure 2: Percentage of Surveyed State Agencies' Total
Expenditures for Drug Abuse Treatment Services by
Funding Source, Fiscal Year 1996 10
Figure 3: Percent of SAPT Block Grant Expenditures for
Methadone Services, Fiscal Year 1996 12
ADATSA Alcoholism and Drug Addiction Treatment and Support Act
HHS Department of Health and Human Services
KDA Knowledge Development and Application
NIDA National Institute on Drug Abuse
SAMHSA Substance Abuse and Mental Health Services Administration
SAPT Substance Abuse Prevention and Treatment
TASC Treatment Alternatives to Street Crime
TOPPS Treatment Outcomes and Performance Pilot Studies
TOPPS II Treatment Outcomes and Performance Pilot Studies Enhancement
Health, Education, and
Human Services Division
B-281927
February 15, 2000
The Honorable John L. Mica
Chairman
The Honorable Patsy Mink
Ranking Minority Member
Subcommittee on Criminal Justice, Drug Policy
and Human Resources
Committee on Government Reform
House of Representatives
Drug abuse continues to be a major national problem and concern. National
survey data show that in 1998, 13.6 million Americans reported that they had
used an illicit drug in the past month. The cost of drug abuse to
society--which includes costs for health care, drug addiction prevention and
treatment, drug-related crime prevention, and lost resources resulting from
reduced worker productivity or death--is estimated at $67 billion annually.
For treatment-related programs, the federal government spent more than $3.2
billion in fiscal year 1998.1 To better understand how federal funds are
used, you asked us to describe efforts by the Substance Abuse and Mental
Health Services Administration (SAMHSA) and states to provide effective drug
abuse treatment programs. Specifically, you asked us to describe (1)
activities supported by SAMHSA's Substance Abuse Prevention and Treatment
(SAPT) block grant and Knowledge Development and Application (KDA) grant
funds for drug abuse treatment; (2) SAMHSA and state mechanisms for
monitoring fund use; and (3) SAMHSA and state efforts to determine the
effectiveness of drug abuse treatment supported with SAPT block grant funds.
Our work on SAPT program activities included a survey of the 16 states that
received at least $25 million for their fiscal year 1996 SAPT block grant
award: California, Florida, Georgia, Illinois, Indiana, Maryland,
Massachusetts, Michigan, New Jersey, New York, North Carolina, Ohio,
Pennsylvania, Texas, Virginia, and Washington. We interviewed selected
respondents on their use of these funds for residential and outpatient drug
abuse treatment services, including detoxification and methadone
maintenance. We asked states to exclude their use of SAPT block grant funds
for activities other than drug abuse treatment, such as alcohol treatment
and prevention from their survey responses. We also interviewed officials in
SAMHSA's Center for Substance Abuse Treatment, Office of Program Services,
and Office of Applied Studies, and reviewed documents they provided on SAPT
and KDA activities funded with drug abuse treatment dollars.
Although the 16 states we surveyed represented about 60 percent of SAPT
block grant drug abuse treatment expenditures for services, the results of
our survey are not necessarily generalizable to all states. Our review
focused on expenditures of fiscal year 1996 drug abuse treatment funds
because, at the time of our review, it was the latest year for which
complete expenditure data from SAMHSA and the states on the SAPT block grant
were available. Also, some survey states provided estimates of drug abuse
treatment expenditures because they could not separate drug from alcohol
abuse treatment services or could not isolate SAPT block grant expenditures
from their total drug abuse treatment expenditures. (See app. I for a
detailed description of our scope and methodology.) We did our work from
January 1999 to January 2000 in accordance with generally accepted
government auditing standards.
The federal government has made a considerable investment in states' drug
abuse treatment programs, and although there is currently little information
on their effectiveness, SAMHSA and some states have efforts under way to
measure these programs' outcomes. About $581 million in SAMHSA's fiscal year
1996 grant funds was spent on drug abuse treatment activities. Of these
funds, more than 80 percent ($478 million) was spent by all states for
treatment services funded through the SAPT block grant program. The 16
states we surveyed reported that SAPT funds supported both residential and
outpatient drug abuse treatment services, including detoxification and
methadone maintenance. For half of the states in our survey, outpatient drug
abuse treatment services accounted for 57 to 85 percent of their block grant
expenditures; the average of the remaining states' expenditures for
outpatient services was 31 percent. All of the states we surveyed reported
providing methadone treatment services almost exclusively on an outpatient
basis. SAMHSA spent another $25 million of the SAPT block grant for
technical assistance and evaluation activities related to drug abuse
treatment. The remaining $78 million of SAMHSA's fiscal year 1996 grants
were KDA funds provided to community-based organizations, universities, and
state and local government agencies to develop and disseminate information
on promising drug abuse treatment practices.
To monitor grantees' use of SAPT and KDA program funds, SAMHSA uses on-site
reviews, reviews of independent financial audit reports, and application
reviews. These mechanisms are primarily used to monitor grantees' compliance
with program requirements, identify grantees' technical assistance needs,
and provide grantees guidance for improving program operations. The current
accountability system for the SAPT block grant is mostly based on a review
of state expenditures. As a result, SAMHSA primarily monitors states'
compliance with certain statutory requirements for use of funds, such as
those that stipulate that a certain percentage be used to treat special
populations. The states we surveyed also reported that they monitor SAPT
block grant funds provided to third parties, including counties and
providers, using mechanisms similar to SAMHSA's. They used the results of
their monitoring efforts, in part, to make drug abuse treatment funding
allocation decisions and determine technical assistance needs.
Several state and SAMHSA efforts are under way to determine the
effectiveness of drug abuse treatment programs using client outcome
measures, such as drug use, employment, criminal activity, and living
arrangement. Nine of the 16 states that we surveyed have conducted such
assessments, but the outcomes measured, populations assessed, methodologies
used, and availability of results vary from state to state. SAMHSA officials
believe that collecting uniform state-level client outcome and other
performance data is critical to determining the effectiveness of state
programs supported with SAPT block grant funds. Consequently, SAMHSA is
funding a pilot effort to help 19 states develop and uniformly report on a
core set of client outcomes. SAMHSA has also asked all states to voluntarily
report client outcome data in their fiscal year 2000 block grant
application. However, this effort is not likely to result in uniform state
data because some of the states we surveyed reported that they would not be
able to submit all of the requested data because they are not currently
collecting it.
In 1995, SAMHSA estimated that about 8.9 million people in the United States
needed treatment for serious drug abuse problems, including drug dependence,
heavy drug use, or injection drug use. Drug abuse treatment is typically
provided in residential or outpatient settings and uses pharmacotherapy,
psychosocial/behavioral therapy, or both. Pharmacotherapy relies on
medications to interfere with the euphoric effects or manage the withdrawal
symptoms and cravings experienced with illicit drug use. One widely used
medication is methadone, an opioid agonist that blocks or interferes with
the euphoria of heroin, morphine, and other opiate drugs and suppresses
withdrawal symptoms and cravings between treatment doses.
Psychosocial/behavioral therapy may include skills training and a variety of
counseling approaches, including individual, family, or group counseling.
SAMHSA, an agency within the Department of Health and Human Services (HHS),
has primary responsibility for supporting substance abuse treatment and
prevention activities. (See app. II for a detailed description of SAMHSA's
role, program staffing, and budget authority.) SAMHSA awards 95 percent of
SAPT block grant funds to states and U.S. territories to fund local drug and
alcohol abuse treatment and prevention programs and retains 5 percent for
program evaluation and other administrative purposes. State awards are
determined by a statutory formula based on several factors, including a
state's personal income data, taxable resources, population estimates, and
service costs. To obtain a block grant, a state must submit to SAMHSA for
review and approval an annual application that includes a discussion of how
the state intends to comply with the various block grant requirements.
States have broad discretion in how they distribute SAPT block grant funds
to cities, counties, and service providers; the services they support; and
the specific amount allocated to drug abuse treatment. SAPT block grant
legislation specifies that at least 35 percent of the state block grant
award be used for alcohol prevention and treatment activities and 35 percent
be used for other drug abuse prevention and treatment activities. The
remaining 30 percent can be used at the state's discretion for drug
programs, alcohol programs, or both. Further, states are required to satisfy
certain statutory set-aside requirements for allocating a portion of SAPT
funds for special populations, such as pregnant and postpartum women and
their children, and, in certain states, to provide early intervention
services for those with HIV.
SAPT block grant legislation requires that 5 percent of the SAPT block grant
be set aside at the federal level to support data collection, program
evaluation, and technical assistance to the states. For example, this
set-aside funds four major surveys required by the Public Health Service
Act: the National Household Survey on Drug Abuse, the Drug Abuse Warning
Network, the Drug Abuse Services Information System, and the Alcohol and
Drug Services Survey. These surveys are intended to provide information for
formulating substance abuse policy and evaluating the performance of
programs and activities supported with federal funds. Another study
supported by the set-aside, the Services Research Outcome Study, is a
national study that used client outcome measures to assess the effectiveness
of drug abuse treatment.
The KDA program is SAMHSA's discretionary grant program that replaced the
demonstration grant program in 1996.2 KDA program grants are designed to
bridge the gap between knowledge and practice in order to transfer research
findings to community practitioners and to provide new, more efficient ways
to deliver services. Funds are provided to community-based organizations,
universities, and state and local government agencies for developing and
promoting effective approaches to providing substance abuse treatment
services as well as prevention and mental health services. The KDA program
is also used to expand the availability of treatment services for specific
locations and populations. KDA topics are determined based on assessments of
research and needs in the field as well as input from drug abuse experts,
providers, clinicians, and congressional offices. Grant proposals are
screened, peer reviewed, and scored based on criteria that include the
proposed methodology for addressing the KDA topic as well as the populations
to be researched.
The Government Performance and Results Act of 1993 (Results Act)--enacted to
increase federal program effectiveness and accountability--requires federal
agencies to set program goals, measure performance, and report to the
Congress on their accomplishments. SAMHSA develops performance goals for the
SAPT block grant program as part of HHS' Results Act reporting. In 1995, HHS
requested that the National Academy of Science's National Research Council
convene an expert panel to examine and report on the technical issues
involved in establishing performance measures in 10 program areas, including
substance abuse treatment. The conclusions and recommendations from the
report that resulted from this effort were used to support SAMHSA's current
efforts to develop and collect state-level client outcome data.3
and Evaluation
Fiscal year 1996 expenditures for drug abuse treatment activities funded by
SAMHSA's SAPT block grant and KDA grant programs totaled $581 million. About
82 percent of these expenditures supported outpatient and residential
treatment services and methadone maintenance--the pharmacotherapy treatment
most widely used for heroin and other opiate addictions. For the 16 states
we surveyed, outpatient services accounted for almost half of their SAPT
block grant drug abuse treatment expenditures. The remaining 18 percent of
SAMHSA's grant funds for drug abuse treatment activities supported technical
assistance and program evaluation funded by the SAPT block grant set-aside
and the development and dissemination of information on promising treatment
practices funded by the KDA grant program.
Drug Abuse Treatment
In fiscal year 1996, about $581 million in SAMHSA grant funds supported
activities related to drug abuse treatment. State SAPT block grant
expenditures accounted for about $478 million,4 and the SAPT set-aside for
technical assistance contracts and program evaluation efforts accounted for
another $25 million. The remaining $78 million supported KDA grants for
programs designed to develop promising treatment practices that can be used
to improve the provision of substance abuse treatment services and
disseminate information to the public and treatment community.
(See fig. 1.)
Figure 1: Percentage of SAMHSA's Drug Abuse Treatment Expenditures for SAPT
Block Grant and KDA Grant Programs, Fiscal Year 1996
In addition to block grant funds, states use other revenue sources to fund
drug abuse treatment services, including state funds; other federal funds,
such as Medicaid; and county funds and insurance payments. The proportion of
total drug abuse treatment expenditures accounted for by SAPT block grant
expenditures varied considerably among the states we surveyed (see fig. 2).
For example, New York reported that SAPT block grant expenditures accounted
for 18 percent of its total reported funds for drug abuse treatment compared
with 76 percent reported by Indiana. Expenditure data reported by the states
we surveyed result from drug abuse treatment funds that flow through the
state agency responsible for administering the SAPT block grant. In some
states, other agencies also fund drug abuse treatment.
Figure 2: Percentage of Surveyed State Agencies' Total Expenditures for Drug
Abuse Treatment Services by Funding Source, Fiscal Year 1996
Note: Florida, Illinois, Massachusetts, Michigan, North Carolina, Ohio, and
Washington provided estimates of fiscal year 1996 drug abuse treatment
expenditures by funding source. Pennsylvania is not included. Pennsylvania
officials reported that drug abuse treatment expenditure information was not
available for other federal, state, and other funding sources because, aside
from the SAPT block grant, they do not track drug abuse treatment
expenditures separately from alcohol treatment expenditures. The officials
stated that estimates could be constructed using client information but that
such estimates would not take into consideration potential variations in the
cost of treating alcohol versus drug abuse.
a"Other" refers to funds other than state and federal funds, such as county
funds and insurance payments.
b "Other federal" refers to federal funds other than SAPT block grant funds,
such as Medicaid.
Used for Outpatient Services
The 16 states we surveyed reported spending a total of about $300 million of
SAPT block grant funding on drug abuse treatment, which included, for
example, detoxification and methadone maintenance in residential and
outpatient settings. The largest portion of reported drug abuse treatment
expenditures was for services in outpatient settings, which can vary from
psychotherapy to group counseling and may include pharmacological treatment.
Of the 16 states surveyed, 14 reported spending SAPT block grant funds on
outpatient services: 8 states spent between 57 and 85 percent of funds on
these services; the average of the 6 remaining states' expenditures for
outpatient services was 31 percent.5
All of the states we surveyed reported that SAPT block grant expenditures
supported methadone treatment, which is the pharmacotherapy treatment most
widely used for heroin addiction. Methadone maintenance generally requires
clients to receive daily methadone dosages that can continue for several
years and, in some cases, may last a lifetime. The states we surveyed
reported providing methadone maintenance almost exclusively as an outpatient
service. Of the 16 states surveyed, 14 reported spending a total of $42.7
million of fiscal year 1996 SAPT block grant funds for methadone provided on
an outpatient basis.6 SAPT block grant expenditures for methadone services
ranged from 2 percent to about 50 percent of total block grant expenditures
for drug abuse treatment (see fig. 3). This range in expenditures is an
example of the flexibility states have in determining the services supported
by SAPT block grant funds.
Figure 3: Percent of SAPT Block Grant Expenditures for Methadone Services,
Fiscal Year 1996
Note: Illinois, New Jersey, Ohio, Pennsylvania, and Washington officials
provided estimates of SAPT block grant expenditures for methadone services.
Michigan and North Carolina did not provide data on these expenditures and
were, therefore, not included.
Assistance
SAMHSA spent about $25 million of the fiscal year 1996 SAPT block grant
set-aside to provide technical assistance to states and for program
evaluation activities related to drug abuse treatment. About 93 percent of
these funds supported technical assistance activities, including $11 million
for technical assistance contracts and $12 million for the State Treatment
Needs Assessment Program; the remaining $2 million supported program
evaluation activities. At the request of states, SAMHSA uses technical
assistance contracts to provide a wide range of activities, which include
conducting training seminars, redesigning treatment policies and procedures,
and assisting states in establishing cost-effective treatment models. SAMHSA
developed the State Treatment Needs Assessment Program to help states better
allocate treatment funds, enhance and sustain states' capabilities to assess
treatment need, and improve states' reporting of their needs assessments in
block grant applications. In September 1998, we reported that some state
officials have found this program useful for targeting resources and
enhancing service delivery. However, states have been slow in developing the
capacity to assess need and to report results developed from the program in
their SAPT block grant applications.7
Practices
SAMHSA awarded $78 million of fiscal year 1996 KDA discretionary grants to
determine the effectiveness of selected treatment practices, expand the
availability of treatment services for specific locations and populations,
and promote the adoption of best practices and treatment techniques. KDA
funds supported grants and cooperative agreements to 111 community-based
organizations, universities, and state and local government agencies in
support of 13 specific drug abuse treatment programs in fiscal year 1996. In
fiscal year 1998, KDA treatment expenditures increased to about $98 million
supporting 27 specific programs.8 (See app. III for a description of KDA
programs funded in fiscal years 1996 and 1998.) KDA programs funded in these
years include the following:
� Wraparound Services to evaluate the effect that services such as child
care, vocational training, and transportation have on the effectiveness of
treatment services.
� Marijuana −Adults to evaluate the effectiveness of brief treatment
interventions for marijuana dependence and relapse and determine whether
these interventions are effective for individuals from differing
socioeconomic, racial, and ethnic backgrounds.
� Pregnant and Postpartum Women to expand the availability of comprehensive
treatment services for pregnant and postpartum women and their children.
� Rural Remote and Culturally Distinct Populations to provide treatment
services for harder-to-reach populations and serve as a model program for
Alaskan Natives, American Indians, and Native Hawaiians.
� Addiction Technology Transfer Centers to promote the transfer of promising
treatment practices to drug abuse treatment providers.
To help improve the overall quality of substance abuse treatment and
facilitate the adoption of practices that have been identified as effective
treatment approaches, SAMHSA develops and publishes best practice
guidelines. For example, SAMHSA developed treatment improvement protocols by
bringing together clinicians, researchers, policymakers, and other federal
and nonfederal experts to identify and reach consensus on promising
treatment practices. The published protocols recommend strategies to enhance
treatment services for individuals with coexisting mental health and
substance abuse disorders; offer guidelines for the design and delivery of
effective treatment services for adolescents; and offer guidelines for
planning, providing, and evaluating detoxification services. SAMHSA also
developed a protocol to assist state agencies in developing, implementing,
and managing outcome monitoring systems for increasing accountability for
treatment expenditures. The treatment improvement protocols are being
evaluated by an independent contractor to determine their effectiveness.
SAMHSA also publishes technical assistance publications, which compile
materials gathered from various federal, state, programmatic, and clinical
sources that provide guidance and information related to providing substance
abuse treatment services.
SAMHSA coordinates its KDA efforts with the National Institutes of Health's
National Institute on Drug Abuse (NIDA). Coordination activities include
periodic meetings to ensure that NIDA research is considered in the
development, application, and dissemination of KDA information on promising
treatment practices. For example, the KDA programs related to adolescent
treatment, methamphetamine abuse treatment, and interventions for marijuana
abusers reflect clinical research originally funded by NIDA. These KDA
programs test NIDA research to establish the effectiveness of treatment
approaches and to identify and address barriers to the use of these
approaches in different communities and with different populations. SAMHSA
and NIDA also use interagency agreements to draw on each other's expertise
and avoid duplication of effort. SAMHSA also routinely involves NIDA in
selecting treatment improvement protocol topics to ensure that they do not
duplicate activities funded by the National Institutes of Health and in
reviewing the protocols before publication. Further, NIDA grantees
participate on the consensus panels for the development of the treatment
improvement protocols. SAMHSA officials said that they also coordinate with
the National Institute on Alcohol Abuse and Alcoholism.
Grant Funds
SAMHSA uses on-site reviews, reviews of independent financial audit reports
required by the Single Audit Act, and reviews of grant applications to
monitor grantees' use of SAPT and KDA funds and their compliance with
program requirements. The accountability system for SAPT block grant funds
is primarily based on whether states spend SAPT funds as required by federal
law. SAMHSA is statutorily mandated to use on-site reviews to ensure states
comply with requirements for the use of funds, such as the "maintenance of
effort" requirement, which stipulates that states must maintain a certain
level of expenditures for drug abuse treatment. On-site reviews are also
used to identify grantees' technical assistance needs and provide guidance
and recommendations to grantees for improving program operations. States,
which distribute SAPT block grant funds to third parties such as treatment
providers, reported using a variety of mechanisms to monitor third-party use
of SAPT block grant funds. These mechanisms include site visits, management
information systems, cost and activity reports, fiscal audits, and
independent peer reviews. Most of the surveyed states reported using the
results of their monitoring activities to, in part, make funding allocations
and determine technical assistance needs.
and Identify Technical Assistance Needs
SAMHSA is statutorily required to conduct on-site reviews to monitor SAPT
block grant expenditures in at least 10 states each fiscal year. SAMHSA
contracts with an independent firm to conduct these on-site reviews at the
state and local levels. These reviews examine grantees' fiscal monitoring of
providers and compliance with SAPT block grant requirements that include
maintaining a certain level of state expenditures for drug abuse treatment
and spending a certain percentage of funds on services for pregnant and
postpartum women and their children. In practice, each state receives a
review on average once every 3 years, and the review is generally conducted
by one or two persons over a 5-day period. Although the on-site review
process includes collecting and reviewing documents describing agency and
program operations, the primary component of the review is a series of
interviews conducted with state and local program officials. After the
on-site review, the contractor works with SAMHSA program staff and state
officials to develop a report detailing the contractor's findings. SAMHSA
does not currently collect corrective action plans from states or track
states' responses to identified deficiencies to determine if deficiencies
are resolved. SAMHSA officials said that corrective action plans and
SAMHSA's monitoring of them are needed, but the agency has not yet decided
how it will address this issue.
SAMHSA uses the results from the on-site reviews to identify states'
technical assistance needs. For example, Ohio's 1999 review resulted in two
technical assistance recommendations: (1) develop utilization review
guidelines for monitoring grantees and (2) provide training on SAPT block
grant set-aside requirements for funding tuberculosis and HIV services.
States must initiate requests for technical assistance, which SAMHSA
provides through contractors that include experts who specialize in
treatment service issues. In addition to on-site compliance reviews, SAMHSA
project officers periodically conduct site visits to states and local
treatment providers, identifying technical assistance needs and providing
program guidance.
For the KDA program, SAMHSA officials told us that project officers monitor
grantees through site visits as well as conference calls and other regular
meetings. The goal of monitoring KDA programs is to provide technical
assistance and to ensure achievement of program goals. Project officers will
conduct a site visit if a grantee is not making adequate progress toward
meeting KDA project goals. Project officers discuss difficulties that the
grantee is encountering and assist in determining a plan of action for
addressing problems, which may include a recommendation for technical
assistance. Project officers also work collaboratively with study sites to
oversee project design, analysis, and reporting of results.
Monitor Compliance
SAMHSA also reviews grantees' annual financial audits and grant applications
to ensure compliance with program requirements. According to SAMSHA
officials, the agency's primary fiscal monitoring mechanism for grantees is
the agency's review of annual financial audit reports required by the Single
Audit Act. In general, the single audit is designed to determine if a
grantee's financial statements are fairly presented and grant funds are
managed in accordance with applicable laws and program requirements. Under
criteria established in the act, independent auditors use expenditure limits
and risk-based guidelines to identify the programs that will be audited.9
Therefore, if a grantee's SAPT or KDA program expenditures in a given year
fall below the audit threshold of $300,000--or 3 percent of total federal
expenditures--the program is generally not audited in that year. In 1997, 13
SAPT block grantees were not audited.
SAMHSA officials reported using their reviews of independent financial audit
reports to identify grantees that need to take corrective actions to come
into compliance with program requirements. For example, if an audit report
includes recommendations for resolving findings related to grantee
noncompliance, SAMHSA will request a corrective action plan from the grantee
for each recommendation and review grantee submissions for adequate
responses. If a grantee does not submit an audit report or correct audit
findings in a timely manner, or material accounting and financial weaknesses
are repeated in audit reports, SAMHSA has the authority to suspend or
terminate the grant award, or require the grantee to submit additional
financial reports as a condition of receiving additional grant funds.
SAMHSA also uses its review of grantee applications to monitor SAPT block
grant program compliance. SAMHSA project officers are responsible for
reviewing SAPT block grant applications to determine if states have complied
with statutory requirements, such as set-asides for special populations and
maintenance of effort. SAMHSA, however, has approved some states'
applications without addressing their reported maintenance of effort
shortfalls.10 Audit report and on-site review findings as well as a
subsequent internal review of grantees' fiscal years 1994 through 1996 block
grant applications identified seven states that reported noncompliance with
maintenance of effort requirements. If a state fails to comply with the
maintenance of effort requirement, SAMHSA can reduce the state's block grant
award by the amount of the shortfall or request a determination of material
compliance from the Secretary of HHS. SAMHSA can also grant a waiver if the
state has experienced a financial crisis. SAMHSA, however, did not follow
appropriate procedures when states reported maintenance of effort shortfalls
in their block grant applications. In August 1998, SAMHSA developed a plan
to improve its oversight of maintenance of effort issues, which includes
making maintenance of effort compliance the highest priority for initial
staff review, initiating weekly status reports on states with compliance
issues, and conducting internal quarterly assurance meetings to review SAPT
block grant documentation.
Similar to SAMHSA's
The states we surveyed reported using a variety of mechanisms to monitor the
use of SAPT block grant funds provided to third parties, such as counties
and treatment providers. Many of these mechanisms were similar to those used
by SAMHSA. Of the 16 states surveyed, 12 reported using on-site visits,
financial audits of providers, management information systems, and cost and
activity reports. The remaining four states used at least two of these
mechanisms. Some states reported that these mechanisms were used
specifically to monitor provider billing procedures, quality of care, and
providers' compliance with SAPT block grant program requirements.
Most of the surveyed states reported that the results of their monitoring
were used to determine provider and service contracting, funding
allocations, and technical assistance needs. For example, Texas reported
delaying funding or suspending contracts for providers who were not
compliant with program requirements. Washington state officials reported
that monitoring results have been used to identify priority populations for
receiving treatment services. Georgia officials reported that monitoring
results have been used to establish policies for staff training and a
process for allocating treatment funds.
Effectiveness of Drug Abuse Treatment Services
Several efforts are under way to determine whether states receiving SAPT
block grant funds are supporting effective drug abuse treatment programs.
Some states are conducting studies using client outcome measures to assess
the effectiveness of their programs. While SAMHSA has supported national
studies that suggest drug abuse treatment is beneficial in reducing drug
use, increasing employment, and reducing criminal activity, SAMHSA does not
currently know the outcomes of states' drug abuse treatment programs
supported with SAPT block grant funds. To determine the effect states'
programs are having on drug abuse, SAMHSA believes it is critical to collect
uniform state-level client outcome data. Therefore, the agency is currently
conducting a pilot study with 19 states to collect such data. SAMHSA has
also initiated an effort to have states voluntarily report client outcome
data in their block grant applications. However, this effort has limitations
because states do not collect data in the same way; some states do not
collect the data SAMHSA requested; and, according to SAMHSA officials, some
states lack the capacity to collect and report the data.
Treatment
SAMHSA has funded two national studies that suggest drug abuse treatment is
effective at improving outcomes, such as decreasing drug use, criminal
activity, and unemployment. The Services Research Outcome Study is the first
national study of substance abuse treatment outcomes to include a
representative sample of drug abuse treatment programs in rural, suburban,
and urban locations.11 The National Treatment Improvement Evaluation Study,
a 5-year study, examined the effectiveness of treatment provided in public
programs supported by SAMHSA. While these two studies relied on
self-reported data as the primary data collection method, they also used
methods to validate study results. Table 1 summarizes the characteristics of
the two studies and the results of selected outcome measures.
Table 1: Characteristics of SAMHSA's Major Drug Abuse Treatment Studies
National Treatment
Services Research Outcome Improvement Evaluation
Study
Study
Study characteristics
1,799 people, representing
a 65-percent simple 4,411 people, representing
Population response rate and a 67 percent of the total
38-percent cumulative number of clients in the
response ratea study sample
1 month or 1 year before
Measurement time 5 years before treatment treatment compared to 1
frame compared to 5 years after month or 1 year after
treatment
treatment
Hospital inpatient, Methadone, drug-free
Treatment service residential, outpatient outpatient, short- and
methadone, outpatient long-term residential,
nonmethadone correctional
Outcome measures and
results
A 21-percent overall Drug use declined by about
Drug use reduction in the number of 50 percent for as long as
people using any illicit 1 year following
drug following treatment. treatment.
Significant decreases in
Between 23- and 38-percent multiple indicators of
reduction for most crimes, criminal involvement, such
Criminal activity including theft, drug as a 64-percent decrease
sales, prostitution, drunk in arrests and a
driving, and weapon use. 78-percent decrease in
selling drugs.
No appreciable change in Rate of employment
increased by 19 percent,
Employment the rate of full-time and those on welfare
employment for clients
discharged from treatment. decreased by almost 11
percent.
Improved housing was
Living arrangement secured and custody of Homelessness decreased by
children regained after 43 percent.
treatment.
Alcohol and drug-related
Physical health (Not measured.) medical visits declined by
53 percent.
Mental health problems
declined by 35 percent,
Mental health Suicide attempts declined and inpatient mental
following treatment.
health declined by 28
percent.
Sex for money or drugs
decreased by 56 percent,
Sexual activity (Not measured.) and sex with an
intravenous drug user
decreased by 51 percent.
aThe Services Research Outcome Study's client sample was derived from a
sample of treatment facilities identified in the Drug Services Research
Survey, a prior study. Therefore, when the Services Research Outcome Study
is viewed as a longitudinal study (that captures the facilities sample from
the Drug Services Research Survey as well as its completed cases), its
cumulative response rate is 38 percent--the product of the studies' response
rates.
In addition to national studies, SAMHSA is trying to develop state-level
data about drug abuse treatment effectiveness. The results of this effort
will be used to monitor and report to the Congress the performance and
success of individual states' drug abuse treatment programs supported with
SAPT funds. While there is no specific statutory requirement for states to
collect and report outcome data on the results of their treatment programs
supported with SAPT block grant funds, SAMHSA officials stated that having
such data is essential in determining the effect state programs have on the
agency's mission of improving health and reducing illness, death,
disability, and costs to society.
Drug Abuse Treatment
Most states we surveyed have conducted outcome assessments of drug abuse
treatment since 1994, including special studies and ongoing performance
measurement, but their assessments vary in the outcomes measured,
populations assessed, methodologies used, and availability of results. Seven
of the 16 states we surveyed--Florida, Maryland, New York, North Carolina,
Ohio, Texas, and Washington--reported that they have been mandated by state
legislation to assess the outcomes of their drug abuse treatment activities.
For example, North Carolina is required to establish and report performance
outcomes that include abstinence from drug use. In Washington, the governor
holds the Secretary of the state's Department of Social and Health Services
accountable for achieving drug abuse treatment outcomes that are
specifically outlined in the performance contract of the state's director
for alcohol and substance abuse. All states we surveyed plan to begin
assessing treatment programs using outcome measures by the year 2002.
Of the 16 states surveyed, 9 reported having completed at least one outcome
assessment and of them, 7 reported they had completed specific client
outcome studies (see table 2). Seven of the nine states reported they use
performance measurement data to assess drug abuse treatment effectiveness on
an ongoing basis.
Table 2: States' Client Outcome Assessment Activities
States reporting Conducted specific Continually assess client
completed outcome client outcome study outcomes using performance
assessments (number of studies) measurement data
California X (1)
Florida X (1) X
Georgia X (3) X
New York X
North Carolina X (3) X
Ohio X (5)
Texas X (1) X
Virginia X
Washington X (11) X
These states generally use a number of outcome measures to assess their drug
abuse treatment efforts, including abstinence, drug use, employment, mental
and physical health, living arrangement, and criminal activity. However, the
indicators for measuring these outcomes varied. For example, Ohio measures
criminal activity in terms of rearrests, incarcerations, and probation
violations. California measures criminal activity using several indicators
that include the number of times a drug abuser sold or helped sell drugs,
had sex for money or drugs, broke into a house or vehicle, or used a weapon.
In addition, the surveyed states' assessments varied in terms of target
populations, purpose, time frames, or other methodological issues.
Of the nine states that reported conducting outcome assessments,
six−California, Florida, North Carolina, Ohio, Texas, and
Washington−reported benefits as a result of drug abuse treatment.12
(See app. IV for details of the six states' outcome assessments.) For
example, California has conducted a large-scale study that showed treatment
reduced drug use by about 40 percent and criminal activity by about 66
percent. Washington reported that its study of treatment for impoverished
populations showed that quarterly earnings of clients receiving treatment
were more than twice the earnings of clients not receiving treatment and
that health care costs for clients receiving treatment decreased by nearly
50 percent. According to SAMHSA, the National Association of State Alcohol
and Drug Abuse Directors, and substance abuse experts, Washington and New
York are examples of states from which lessons could be learned about
measuring the effectiveness of drug abuse treatment using client outcomes.
For example, Washington's data system uses Social Security numbers to track
clients, enabling the state to integrate self-reported data with secondary
databases, including state employment and welfare rolls, to provide
objective data for measuring client outcomes.13 Washington reported
conducting 12 outcome assessment activities since 1994 and using client
identifiers and integrative techniques for the past 7 to 8 years. New York
officials reported using an integrated program monitoring and evaluation
system since 1995 to assess the performance of all drug abuse treatment
providers. This system uses 12 performance measures, including abstinence
and employment, and has an established set of minimum performance standards.
Drug abuse treatment providers who do not meet the standards are required to
develop an action plan to meet the minimum performance standards.
Uniform State Outcome Data
SAMHSA has initiated efforts to improve existing state data systems to make
them comparable for performance measurement. Specifically, in 1997, SAMHSA
developed the Treatment Outcomes and Performance Pilot Studies (TOPPS) to
help states develop or enhance their management information systems and
outcome monitoring systems for evaluating clients receiving treatment. In
1998, SAMHSA created a grant program to further this effort--the Treatment
Outcomes and Performance Pilot Studies Enhancement (TOPPS II)--which is
being conducted under cooperative agreements with 19 states,14 including 9
that we surveyed. TOPPS II aims to help the pilot states collect information
on SAPT-funded treatment services and monitor a core set of substance abuse
treatment effectiveness measures. Several of the states we surveyed reported
this program as part of their assessment efforts to measure drug abuse
treatment effectiveness.
While the TOPPS initiative supported individually designed state studies to
assess treatment effectiveness, TOPPS II supports a consensus-developed set
of common client outcome measures of treatment effectiveness and
incorporation of these measures into the databases of participating states.
Both SAMHSA and the states participating in TOPPS II agreed on a core set of
outcome measures that include substance abuse, health services utilization,
self-help participation, pregnancy and status of children, employment
status, living arrangements, and criminal behavior. As a condition of
receiving funding through TOPPS II, each of the 19 participating states is
required to report to SAMHSA on each of these measures of treatment
effectiveness. The TOPPS II study will issue interim and final reports that
summarize developments and findings in the state and interstate evaluations.
States are to report final results to SAMHSA in September 2001.
Provide Uniform Data
SAMHSA is asking states to voluntarily report on a core set of outcome
measures--drug use, criminal activity, employment status, and living
arrangements--in the fiscal year 2000 SAPT block grant application.15 For
programs supported with SAPT block grant funds, SAMHSA is asking states to
report the percent change in each measure that has occurred between
admission and discharge for clients completing treatment, by age and
race/ethnicity, using specific indicators such as arrests and
homelessness.16 Further, SAMHSA is asking states to report the source of the
data, reasons for not being able to report the data, and whether information
is available to measure outcomes after treatment is completed.
SAMHSA's effort to have all states voluntarily report outcome data in their
fiscal year 2000 SAPT block grant application, however, will not yield
consistent and uniform data across states because some states reported that
they are not currently collecting all the outcome data that SAMHSA is
requesting. Of the 16 states we surveyed, 8 plan to report data on some of
the outcome measures; 4 of these states--California, Maryland, New York, and
Washington--are participating in SAMHSA's TOPPS II program. For example,
Georgia officials stated that they will report outcome information to SAMHSA
in the fiscal year 2000 block grant application but do not have the data
needed to report outcomes by race and age as requested by SAMHSA. The
remaining eight states we surveyed reported that they will not or are unsure
whether they will report the outcome information because they are not
currently collecting much of the data SAMHSA requested.
SAMHSA officials are still reviewing applications and said that they are
unsure of the extent to which states will report complete and consistent
client outcome information in their SAPT block grant applications. SAMHSA
plans to use the information it collects to identify states' ability to
report outcome data, such as the availability of state outcome data, the
complexities of measuring client outcomes, and states' infrastructure needs
for measuring outcomes. SAMHSA officials stated that improving states'
ability to collect client outcomes and requiring them to report on a uniform
set of measures would enhance SAMHSA's ability to obtain uniform and
consistent client outcome data across states. In November 1999, HHS' general
counsel, together with SAMHSA officials, determined that the Secretary of
HHS has the authority to require such information for administering the
program. However, according to SAMHSA officials, it is highly unlikely that
the states could currently report the quality of data needed to make
accurate program assessments.
The federal government invests hundreds of millions of dollars for drug
abuse treatment through the SAPT block grant program. While SAMHSA monitors
state expenditures to determine whether block grant funds are used in
accordance with statutory requirements, this type of monitoring is not
designed to determine the effect state drug abuse treatment programs are
having on client outcomes. Assessing the effectiveness of drug abuse
treatment is important in ensuring federal and state accountability for
program results. Some states are assessing the effectiveness of their
treatment programs using various outcome indicators. SAMHSA officials
believe that the collection of uniform state-level client outcome data is
essential for determining the effectiveness of drug abuse treatment programs
supported with federal funds and for reporting the information to the
Congress. SAMHSA is trying to determine the availability of client outcome
data from all states and has awarded grants to some states to help improve
their data collection systems. These efforts should help identify states'
views about and some of the complexities associated with collecting and
reporting client outcome data. SAMHSA's efforts should also help to
determine what additional actions are needed to get uniform state reporting
on the results of drug abuse treatment programs supported with SAPT block
grant funds.
We provided a draft of this report to SAMHSA and the 16 states we surveyed.
SAMHSA officials said that the report provided an accurate and thorough
review of the agency's SAPT block grant and KDA grant programs. SAMHSA and
some of the 14 states that responded to our request for comments had
additional information, clarifications, and technical comments, which we
incorporated where appropriate.
As agreed with your office, unless you publicly announce its contents
earlier, we plan no further distribution of this report until 5 days from
the date of this letter. At that time, we will send copies to the Honorable
Donna E. Shalala, Secretary of HHS; the Honorable Nelba Chavez,
Administrator of SAMHSA; officials of the state substance abuse agencies we
surveyed; appropriate congressional committees; and other interested
parties. We will also make copies available to others upon request.
Please contact me at (202) 512-7119 or James O. McClyde, Assistant Director,
at (202) 512-7152, if you or your staff have any questions. Other major
contributors to this report were Veronica Henry and Janina Johnson.
Janet Heinrich
Associate Director, Health Financing
and Public Health Issues
Objectives, Scope, and Methodology
In response to congressional concern about how federal drug abuse treatment
funds are accounted for and whether they support effective drug abuse
treatment programs, we were asked to describe the activities supported by
SAMHSA's SAPT block grant and KDA grant funds for drug abuse treatment, the
mechanisms SAMHSA and states have in place to monitor fund use, and SAMHSA
and state efforts to determine the effectiveness of drug abuse treatment
supported with SAPT block grant funds.
To conduct our work on SAMHSA's SAPT block grant program, we surveyed 16
states--California, Florida, Georgia, Illinois, Indiana, Maryland,
Massachusetts, Michigan, New Jersey, New York, North Carolina, Ohio,
Pennsylvania, Texas, Virginia, and Washington--and conducted follow-up
interviews with selected respondents. We selected these states because they
received at least $25 million for their fiscal year 1996 SAPT block grant
award; further, substance abuse experts and knowledgeable officials
identified some of these states as having well-established systems for
collecting outcome data and assessing their drug abuse treatment programs.
Our review focused on expenditures of fiscal year 1996 drug abuse treatment
funds because it is the most recent year for which complete expenditure data
are available on the SAPT block grant from SAMHSA and the states. States
have 2 years to spend their SAPT block grant award and generally report
expenditures in the third year.
Through our survey and interviews, we collected information on (1) grantees'
expenditures for the different categories of drug abuse treatment services
states report in their annual SAPT block grant applications--residential,
outpatient, detoxification, and methadone; (2) the mechanisms used to
monitor the use of these grant expenditures; and (3) assessments of drug
abuse treatment effectiveness conducted since 1994 using client outcomes,
including measuring performance on an ongoing basis or through periodic
special studies. We asked states to exclude their use of SAPT block grant
funds for other activities, such as alcohol treatment and prevention, from
their survey responses.
We also interviewed officials in SAMHSA's Center for Substance Abuse
Treatment, Office of Program Services, and Office of Applied Studies, and
reviewed documents they provided on (1) SAPT block grant and KDA grant
activities funded with drug abuse treatment dollars; (2) mechanisms SAMHSA
uses to monitor grantees' use of funds and compliance with program
requirements; (3) efforts to assess the effectiveness of treatment using
client outcomes; and (4) SAMHSA's administrative expenses, including
contracts and staffing levels. In addition, we obtained the views of
officials at the National Association of State Alcohol and Drug Abuse
Directors and experts in the substance abuse research community on assessing
the effectiveness of drug abuse treatment using client outcomes.
Although the 16 states we selected to survey represented about 70 percent of
fiscal year 1996 SAPT block grant awards and 60 percent of SAPT block grant
drug abuse treatment expenditures for services, the results of our survey
are not necessarily generalizable to the nation. Also, some survey states
provided estimates of drug abuse treatment expenditures because they could
not separate drug from alcohol abuse treatment services or could not isolate
SAPT block grant expenditures from their total drug abuse treatment
expenditures. We did not independently verify the accuracy of grantees' drug
abuse treatment expenditures. However, we compared some of the expenditure
data reported in our survey with grantee expenditures reported to SAMHSA in
their approved SAPT block grant applications and found no material
differences. We did our work from January 1999 to January 2000 in accordance
with generally accepted government auditing standards.
History and Administration of SAMHSA
In October 1992, the Congress established SAMHSA under Public Law 102-321 to
strengthen the nation's health care delivery system for prevention and
treatment of substance abuse and mental illnesses. Specifically, SAMHSA was
to develop national goals and model programs; coordinate federal policy
related to providing prevention and treatment services; and evaluate the
process, outcomes, and community impact of prevention and treatment
services. Before 1992, the major federal substance abuse and mental health
delivery services and research activities were combined under one agency,
the Alcohol, Drug Abuse, and Mental Health Administration. In the 1992
legislation, the Congress created SAMHSA to administer the services portion
of the former agency and transferred its research components to the National
Institutes of Health to be carried out by the National Institute on Alcohol
Abuse and Alcoholism, NIDA, and the National Institute of Mental Health.
Since 1992, SAMHSA's budget has remained relatively stable at about $2
billion each year. SAMHSA's fiscal year 1999 budget was about $2.5 billion
for substance abuse treatment and prevention and mental health services.
About $1.6 billion was for the SAPT block grant program--95 percent of which
is allocated to states and local governments. SAMHSA allocated another $329
million to fund prevention and treatment discretionary grant programs. A
portion of SAMHSA's budget is appropriated for administrative
expenses--about 6 percent ($155 million) for fiscal year 1999. The majority
of the administrative expense appropriation supports contractual services
that include technical assistance and program evaluation activities.
Administrative expenses also support personnel compensation. As of December
1999, SAMHSA employed a total of 538 people, who are centrally located in
the Washington, D.C., metropolitan area. The remaining administrative funds
support costs related to travel, communications, printing, supplies, and
rental payments. Table 3 lists SAMHSA's fiscal year 1999 appropriated
amounts for administrative expenses; table 4 describes selected SAMHSA
fiscal year 1999 contracts for technical assistance and program evaluation;
and table 5 lists SAMHSA's staffing levels by program as of December 1999.
Table 3: SAMHSA's Administrative Expenses, Fiscal Year 1999 Appropriation
Administrative expenses Fiscal year 1999 appropriation
Personnel compensation and benefits $47,031,000
Printing and reproduction 3,608,000
Communications, utilities, and
miscellaneous charges 1,401,000
Travel 1,199,000
Supplies and materials 392,000
Transportation of things 105,000
Rental payments 40,000
Other contractual servicesa 101,576,000
Total $155,352,000
aExcludes about $62 million in contractual services related to SAMHSA's
block grant set-asides, drug surveys, and program evaluation; includes
indirect costs estimated at 19.5 percent, with contractor fees of 5.1
percent.
Source: HHS Fiscal Year 2000 Substance Abuse and Mental Health Services
Administration Justification of Estimates for Appropriations Committees.
Table 4: Selected SAMHSA Contracts for Technical Assistance and Program
Evaluation, Fiscal Year 1999, by Agency and Program
Continued
Contractor Description Amount
Center for Substance Abuse Treatment
SAPT Block Grant
Help states prepare technical
assistance plans to resolve
Johnson, Bassin & Shaw, deficiencies identified in
Inc., Silver Spring, Md. on-site technical reviews, and $5,686,113
improve linkages between the drug
abuse treatment system and other
social service systems.
Provide technical assistance to
maintain the Treatment
Health Systems Research, Improvement Exchange database,
Inc. Washington, D.C. logistical assistance for 1,088,632
meetings, and editorial expertise
for reports and documents.
KDA/Targeted Capacity Expansion
Provide technical assistance and
support of KDA grants funded in
fiscal years 1996 through 1998
R.O.W. Sciences, Inc., and 2000 through 2002, and
Rockville, Md. ongoing demonstration programs of 3,635,571
the Center for Substance Abuse
Treatment's Division of Practice
and Systems Development.
Establish a program to ensure
that knowledge developed by
CDM/JBS Joint Venture, Chevy projects funded by the Center for
Chase, Md. Substance Abuse Treatment is 3,504,201
disseminated to substance abuse
treatment and related fields.
Provide support for a
coordinating center to facilitate
Johnson, Bassin & Shaw, transfer of business and
Inc., Silver Spring, Md. management technology to 3,298,997
organizations and entities that
make up the public sector
treatment system.
Primarily provide support for the
Residential Women and Children,
Pregnant and Postpartum Women and
Caliber Associates, Fairfax, Children, and HIV Outreach
Va. programs' cross-site evaluation 3,234,270
initiatives, and provide selected
technical assistance to KDA
grantees.
Provide a wide array of data
management and scientific support
Caliber Associates, Fairfax, across various programmatic and
Va. evaluation activities, including 2,767,868
grants, cooperative agreements,
and contracts.
Provide technical assistance for
the Targeted Capacity Expansion
Birch & Davis Associates, cross-site evaluation, including
Inc., Silver Spring, Md. support for implementing data 1,970,758
collection systems, conducting
data analyses, and preparing
reports.
Develop a field evaluation of the
treatment improvement protocols
in order to assess treatment
Johnson, Bassin & Shaw, provider awareness and
Inc., Silver Spring, Md. implementation, and to evaluate 1,597,259
the effects of the protocols on
the process and outcomes of
addiction treatment.
Develop an integrated database of
mental health and substance abuse
The Medstat Group, Inc., treatment services spending
Washington, D.C. estimates that will allow for 1,379,585
comparisons to national health
expenditures.
Center for Substance Abuse Prevention
SAPT Block Grant
Provide technical assistance to
states on complying with SAPT
block grant requirements and
Johnson, Bassin & Shaw, developing systems to administer
Inc., Silver Spring, Md. successful and cost-effective 3,584,997
prevention services, and support
on-site monitoring of states'
block grant funds and programs.
Assist with developing and
disseminating knowledge about
what works in prevention and
making available to states and
Research Foundation, John the field useful tools for
Jay College, CUNY, New York, developing prevention plans, 3,469,057
N.Y. making resource allocation
decisions, implementing
appropriate and effective
prevention programs, and
satisfying demands for public
accountability.
Assist states in the development
Macro International, Inc., of data systems designed to
Calverton, Md. monitor prevention service 1,333,586
delivery.
KDA
This contract carries out the
Corporate Alliance on Drug
Education earmark, which has been
included within the center's
CRP, Inc., Washington, D.C. budget for the past several 1,703,145
years. It also provides SAMHSA
logistical support, including
training and technical assistance
on evaluating prevention
programs.
Assist the Center for Substance
Abuse Prevention with
Caliber Associates, Fairfax, coordinating program data and
Va. producing analytic reports. 1,498,708
Contract also includes monitoring
and analyzing performance
measurements.
Conduct a process and outcome
EMT Associates Inc., Folsom, evaluation of 47 high-risk
Calif. substance abuse prevention 1,168,057
programs for youth, funded in
1994 and 1995.
Assist with developing,
collecting, and analyzing outcome
measures across Workplace Managed
The CDM Group, Inc., Chevy Care program grantees; support
Chase, Md. the planning, development, and 1,086,895
implementation of a series of
specialized work groups and
meetings on workplace issues.
Center for Mental Health Services
Children's Programs
Provide grantees of the
Comprehensive Community Mental
Health Services for Children and
Their Families Program with
American Institute for training and technical assistance
Research, Washington, D.C. for developing community-based 3,947,394
and family-focused services and
integrating child and family
services into local comprehensive
systems of care.
Assess the effectiveness of the
systems of care created by the
Comprehensive Community Mental
Macro International, Inc., Health Services Program for
Calverton, Md. Children and Adolescents, as 3,127,160
required by statute. This funding
was for evaluations of 26
grantees.
Assess the effectiveness of the
systems of care created by the
Comprehensive Community Mental
Macro International, Inc., Health Services Program for
Calverton, Md. Children and Adolescents, as 2,274,583
required by statute. This funding
was for evaluations of 20
grantees.
Develop and implement a
Vanguard Communications of community-based, local and
Falls Church, Washington, national marketing campaign, and 2,091,988
D.C. disseminate campaign messages and
products to reduce the mental
health stigma.
Continue the evaluation of the
Comprehensive Community Mental
Macro International, Inc., Health Services Program for
Calverton, Md. Children and Adolescents focusing 1,346,466
on services for children and
adolescents with serious
emotional disturbances.
Evaluate children's mental health
in urban communities, including
American Institute for state commitments to mental
Research, Washington, D.C. health services programs and 1,064,853
integration of family-centered
concepts and teaching strategies
in medical education.
KDA
Provide support for the School
Violence Prevention grantee sites
by developing products and
activities to communicate with
The Gallup Organization, primary and secondary target
Rockville, Md. audiences, and enhance awareness, 2,006,000
understanding, and application of
strategies aimed at school
violence prevention and healthy
child development.
Evaluate the Access to Community
R.O.W. Sciences, Inc., Care and Effective Services and
Rockville, Md. Support Demonstration Program for 1,399,880
Homeless Persons with Serious
Mental Health Illnesses.
Mental Health Block Grant
Provide support for the Mental
Health Statistical Improvement
Masimax Resources, Inc., Program, specifically the policy
Rockville, Md. group, operations of task forces, 1,196,093
regional and decision application
groups, and further development
of the managed care data system.
Office of Program Services
Provide support for local area
Orkand Corporation, Falls network operation, microcomputer
Church, Va. technical services, software 1,449,921
training, ADP technical studies,
and database administration.
Office of Applied Studies
Assess the value of the Drug
Abuse Warning Network in relation
Westat, Inc., Rockville, Md. to the needs of its users and 1,000,000
make recommendations for an
alternative design.
Office of Planning and Program Coordination
Provide technical,
MayaTech Corporation, Silver administrative, and logistical
Spring, Md. support for peer review meetings 1,000,000
that evaluate grant applications
and contract proposals.
Note: These contracts represent $64 million, or 64 percent, of contracts
SAMHSA specifically identified for technical assistance and program
evaluation and account for those contracts in fiscal year 1999 whose dollar
values are $1 million or greater. There were 95 other contracts with values
less than $1 million funded in fiscal year 1999.
Table 5: SAMHSA's Staffing Levels by Program, as of December 1999
Continued
Grade-level
Executive Commissioned
staff Total
Program and activity staff (GS-1 to GS-15) officers
Center for Substance Abuse
Treatment
KDA/targeted capacity
expansion 0 55 4 59
SAPT block granta 0 21 5 26
Public communicationsb 0 7 0 7
Program support 0 6 0 6
Program planning/advisory
councils 0 10 1 11
Center management 2 4 0 6
103
(16 GS-15s; 26
Total staffing 2 GS-14s; 32 10 115
GS-13s; and 29
GS-12s or
lower)
Center for Substance Abuse
Prevention
KDA/targeted capacity
expansion/high-risk youth 1 33 2 36
SAPT block granta 0 19 1 20
Other substance abuse
programsc 0 17 0 17
Public communicationsb 0 21 1 22
Program support 0 4 0 4
Program planning/advisory
councils 0 11 1 12
Center management 1 5 1 7
110
(11 GS-15s; 29
Total staffing 2 GS-14s; 36 6 118
GS-13s; and 34
GS-12s or
lower)
Center for Mental Health
Services
KDA 0 42 2 44
Mental health block granta1 12 0 13
Children's program 0 10 0 10
Homeless programsd 0 2 0 2
Protection advocacy 0 1 0 1
Other mental health
programse 0 11 1 12
Public communicationsb 0 10 3 13
Program support 0 8 1 9
Center management 1 7 1 9
103
(12 GS-15s; 27
Total staffing 2 GS-14s; 29 8 113
GS-13s; and 35
GS-12s or
lower)
Office of the
Administrator
Operating division/public
communicationsb 0 12 0 12
Grants/contract reviewf 0 10 3 13
Other operating
division/crosscutting 0 19 1 20
programsg
Program
planning/coordination 1 8 0 9
Operating division
managementh 3 16 0 19
65
(13 GS-15s; 14
Total staffing 4 GS-14s; 14 4 73
GS-13s; and 24
GS-12s or
lower)
Other SAMHSA Offices
91
Office of Program (7 GS-15s; 14
Servicesi 1 GS-14s; 26 0 92
GS-13s; and 44
GS-12s or
lower)
26
(6 GS-15s; 11
Office of Applied Studies 1 GS-14s; 5 0 27
GS-13s; and 4
GS-12s or
lower)
Total 12 498 28 538
aThe number of staff assigned to block grant programs represents only those
staff who work directly on the programs in the centers' divisions of state
programs. However, numerous other staff support block grant programs
directly or indirectly, including statistical staff who calculate state
allocations and budget support, grants management, and audit staff.
bIncludes development of program materials, prevention communications,
public information clearinghouses, public service messages.
cIncludes minority health concerns, workplace programs, and managed care
programs.
dIncludes Projects for Assistance in Transition From Homelessness Program, a
formula grant program.
e Includes emergency programs, clinical training pay back, monitoring,
managed care, surgeon general's report, and bioterrorism.
fConducted within the Division of Extramural Activities, Policy, and Review.
gIncludes minority health program, women's health program, HIV/AIDS program,
managed care program, and alcohol program.
hIncludes equal employment programs.
i Includes grants management, contracts management, financial management,
information resources management, human resources management, and
administrative services.
KDA Grant Programs and Funding for Drug Abuse Treatment
Continued
Fiscal year 1996 Fiscal year 1998
Program Description Grantees Funding Grantees Funding
Help metropolitan
areas increase the
effectiveness of
treatment delivery
by developing a
model infrastructure
Target Cities to expand and 10 $20,340,000 7 $1,526,448
coordinate local
health care and
social service
delivery systems
with specialized
addiction treatment
networks.
Address gaps in
treatment capacity
by supporting rapid
Targeted Capacity Expansionand strategic a a 41 23,731,977
responses to demands
for substance abuse
treatment services.
Foster participation
of those who are
recovering from
substance abuse in
the development of
substance abuse
Recovery Community Support treatment services a a 19 3,661,892
and programs,
policies, and
quality assurance
activities at the
state and local
levels.
Evaluate the
benefits and
cost-effectiveness
of these services as
they relate to
Wraparound Services substance abuse 1 1,196,733 1 2,004,823
treatment given
changes in health
care financing,
including managed
care.
Study the
effectiveness of a
program for
substance-busing
women eligible for
Welfare-to-Work Temporary Assistance a a 1 300,000
to Needy Families to
receive treatment
for alcohol and/or
drug addiction and
to become employed.
Establish a more
effective continuum
of care by
integrating
substance abuse
Residential Women and services with
Children general health care, 26 16,524,873 15 13,804,411
providing
comprehensive
services for
addicted women and
their children.
Expand the
availability of
comprehensive
Pregnant and Postpartum treatment services
Women for pregnant and 17 14,875,127 4 2,893,776
postpartum women and
their children with
alcohol and other
drug use problems.
Generate and apply
empirical knowledge
about the
development and
effectiveness of an
Violence Against Women integrated systems a a 9 5,229,228
approach for
assisting women with
co-occurring
disorders and their
children.
Test the
effectiveness of
integrating mental
health and substance
abuse prevention and
Starting Early Starting treatment services
Smart with primary health a a 12 2,575,567
care or early
childhood service
settings for
children from birth
to age 7 and their
families.
Adjunct to the
Criminal Justice
Networks Program to
provide supplemental
funds to existing
Center for Mental
Children's Mental Health Health Services'
Services programs that a a 1 99,749
support
community-based
substance abuse and
mental health
services for
children and
families.
Network of centers
to ensure that
treatment
Addiction Technology professionals have
Transfer Centers the latest 11 7,148,339 15 7,565,505
information on best
practices and
treatment
techniques.
Link metropolitan
justice agencies
with substance abuse
Criminal Justice Treatment treatment networks
Networks and related health, 7 6,074,987 7 8,148,230
mental health, and
social services
agencies.
Support the
evaluation of the
relative
effectiveness of a
variety of pre- and
Criminal Justice Jail post-booking police
Diversion diversion and a a 7 2,999,999
criminal justice
intervention models
for individuals with
co-occurring
disorders.
Modify behavior and
reduce the incidence
of HIV and related
HIV Outreach diseases by 11 3,406,999 a a
targeting high-risk
substance abusers
and their partners.
Collaboration among
six federal agencies
to study integrated
HIV/AIDS Cost Study mental health, a a 9 950,000
substance abuse, and
primary medical HIV
treatment
interventions.
Enhance knowledge
about how managed
Managed care in the public
Care−Vulnerable sector affects the 7 3,234,846 6 3,357,520
Populations provision of
substance abuse and
mental health
services.
Examine the effects
on cost,
utilization, and
Managed outcomes of
Care−Adolescents different models of a a 7 4,177,676
managed care for
adolescents with
substance abuse
problems.
Evaluate the
effectiveness of
Managed Care−Alcohol alcoholism services
Services delivery in a a a 1 199,999
managed care
environment.
Deliver treatment
services in
innovative ways to
hard-to-reach
populations and to
Rural Remote and Culturallyserve as a model
Distinct Populations program to be 3 1,765,000 3 2,018,782
replicated for
Alaskan Natives,
Native Americans,
and Native
Hawaiians.
Supplemental funding
to the Center for
Mental Health
Services to continue
and augment mental
health and substance
abuse treatment
services and enhance
Farm Resource Center outreach to rural, a a 1 50,000
coal mining, and
farm populations in
West Virginia and
Illinois, especially
to those who are
poor, disabled, or
elderly and to
child-bearing women.
Examine the efficacy
of brief treatment
interventions for
marijuana dependence
and whether these
Marijuana−Adults treatments are 4 1,288,805 4 1,844,311
effective in diverse
populations with a
higher proportion of
minority
representation.
Examine the
effectiveness of
treatment for
marijuana-dependent
Marijuana−Adolescentsyouth, comparing a a 5 3,219,164
five promising
approaches that vary
in orientation,
duration, mode of
delivery, and cost.
Test the
replicability of
specific
nonresidential
Methamphetamine Treatment programs for the a a 8 3,024,100
treatment of
methamphetamine
abuse and their
cost-effectiveness.
Document
homelessness
prevention models
for individuals with
serious mental
illness and
substance abuse
Homelessness Prevention disorders who are 12 1,040,695 8 1,826,921
homeless, formerly
homeless, or at risk
for homelessness and
who have had contact
with the mental
health or substance
abuse treatment
system.
Provide expanded
substance abuse
Disaster Assistance treatment services 1 663,708 a a
during a natural
disaster.
Develop a model
comprehensive
program for the
Campus treatment of 1 600,000 a a
substance abuse in
the national capital
area.
Provide
doctoral-level
training to increase
the number of
professionals
qualified to develop
Minority Fellowship and implement a a 4 340,000
services for
underserved ethnic
populations with
mental health and
substance abuse
problems.
Identify those
regimens for
treating adolescent
Exemplary heroin abusers that
Programs−Adolescents appear to be a a 5 2,116,079
exemplary and may be
useful for further
replication and
dissemination.
Support the adoption
of exemplary
practices for
Community Action Grants Hispanic adults and a a 3 442,944
adolescents with
mental health or
substance abuse
problems.
Support domestic
Conference Grant conferences for a a 7 309,066
knowledge synthesis
and dissemination.
Total 111 $78,160,112 210 $98,418,167
aProgram not funded.
State Program Assessments
Continued from Previous Page
Selected outcome
State and program Client Treatment measures and
populations services
results
California
Drug use declined
by 40 percent.
Employment results
not conclusive.
California Drug and
Alcohol Treatment All clients All services Hospital admissions
Assessment reduced by 33
percent.
Criminal activity
declined by 66
percent.
Florida
Abstinence for 65
percent of children
Ongoing performance and 61 percent of
measurement system All clients All services adults.
Employment achieved
by 63.4 percent.
11 percent of
clients completing
treatment who were
drug free at
discharge reported
a substance abuse
problem, compared
to 26 percent of
Evaluation of clients who did not
Substance Abuse Adults Residential, complete treatment.
Treatment Outcomes outpatient
70 percent of
clients who
completed treatment
were employed,
compared to 58
percent of clients
who did not
complete treatment.
North Carolina
Declines in drug
use improved
significantly.
Abstinence improved
significantly.
Ongoing performance Outpatient, case Employment modestly
measurement system All clients management improved.
Mental health
moderately
improved.
Living arrangement
modestly improved.
Drug use declined
substantially for
each type of
substance.
Medical overnight
stays reduced by 4
TOPPS All clients Outpatient percent, and
emergency room
visits reduced by
18 percent.
Psychiatric
overnight stays
reduced by 16
percent.
73 percent of
Perinatal and clients had
Maternal Substance Pregnant and Prenatal full-term births;
Abuse Treatment postpartum women treatment 13 percent of
Initiative and adolescents births born at very
low birth weight.
Abstinence occurred
for 48 percent at
discharge.
Treatment Drug use for those
Alternatives to Criminal justice All services still using drugs
Street Crime (TASC) was less often.
82 percent had no
arrests while in
the program.
Abstinence from
injected drug use
for 94 percent.
Drug use urine
screens for opiates
negative for 79
percent; for
cocaine, 88
percent.
Methadone Treatment Employment
Quality Assurance Narcotic Methadone full-time for 54
System addicted percent.
No medical
overnight stays for
93 percent, and no
emergency room
visits for 82
percent.
No arrests in the
past 12 months for
95 percent.
Ohio
Abstinence occurred
for 76 percent of
discharges.
TASC Court-referred All treatment Drug use testing
juveniles negative for 92
percent.
Rearrest rate: 7
percent.
Abstinence occurred
for 47 percent of
discharges.
Drug use urine
testing negative
for 88 percent; for
breath testing, 91
percent.
TASC Court-referred All treatment
adults Employment obtained
and improved for
1,017 clients, or
46 percent of
discharges.
Living arrangement
stable for 1,132,
or 51 percent of
discharges
Criminal activity
Analysis of Adult Court-referred Counseling, significantly lower
TASC adults urinalysis for clients
completing the
program.
Arrest and
Reincarceration Adult male Therapeutic Rearrests were
Following Prison felons community slightly reduced
Release among participants.
Tapestry
Therapeutic
Community; Our Female and male Residential, Women had lower
Awareness of Self incarcerated other drug abuse rearrests; males,
Increases Success felons treatment no difference.
Therapeutic
Community
Texas
Abstinence achieved
by 56 to 61 percent
for alcohol and
Treatment Research Residential, other drugs.
Institute Adults outpatient
Employment achieved
by 51 to 64
percent.
Treatment Criminal activity
Alternatives to decreased the
Incarceration Adult criminals Outpatient longer the stay in
Program treatment.
Abstinence occurred
for 72 percent of
clients.
Detoxification, Drug use reduced
Statewide Treatment residential, for 64 percent.
Outcome Data Adults outpatient,
methadone Employment gained
by 33 percent.
Arrest rate at
followup was 5
percent.
Washington
Physical health
Cost Savings in Intensive costs $4,500 less
Medicaid Medical Indigents inpatient, than for untreated
Expenses outpatient clients over 5-year
period.
Employment earnings
more than double
Alcoholism and Drug that of untreated
Addiction Treatment Intensive clients.
and Support Act Indigents inpatient,
(ADATSA): Economic outpatient, Physical health
Benefits and Costs residential costs decreased by
nearly 50 percent
for treated
clients.
Employment earnings
for those who
ADATSA Treatment Intensive completed training
Outcomes: inpatient, nearly doubled.
Employment and CostIndigents outpatient,
Avoidance vocational Physical health
training costs were less
than half that of
nontreated clients.
Employment earnings
Employment Outcomes Intensive increased on
of Indigent Clients inpatient, average by $1.30
Receiving Alcohol Indigents outpatient, for every day of
and Drug Treatment recovery house inpatient care
received.
Employment Outcomes Employment earnings
of Chemical Intensive were higher for 46
Dependency inpatient, percent of clients
Treatment and Indigent outpatient, who completed
Additional vocational vocational
Vocational Services training services.
Substance Abuse, Prenatal Overall rate of low
Treatment, and treatment, birth weights for
Birth Outcomes for Pregnant and prenatal and infants whose
Pregnant and postpartum women postpartum mothers were
Postpartum Women diagnosis, treated was lowered
Medicaid by 2.9 percent.
Mental health
services declined
Mentally ill, after treatment 7
chemically to 25 percent.
Evaluation of addicted, and
Pioneer Center involuntary Residential Physical health
North chemical (nonhospital) costs decreased
dependency between $2.2
treatment million and $1.1
million for those
who received
treatment.
Abstinence achieved
for 6 months on
average by about 40
percent of clients.
Number of drug
substances used
dropped by about 3.
Mental health
problems decreased
from 42 percent to
29 percent in
psychiatric
symptoms.
Division of Alcohol Intensive
and Substance Abuse inpatient Physical health
One-year AdolescentAdolescents (nonhospital), problems decreased
Outcomes Report outpatient from 17 percent to
11 percent in
medical
hospitalization and
42 percent to 28
percent in
emergency room
visits.
Criminal activity
decreased in arrest
for misdemeanors by
25 percent,
felonies by 23
percent, and drug
violations by 24
percent.
Abstinence was
achieved for 6
months on average
by about 45 percent
of the clients.
Employment
absenteeism or
tardiness dropped
by 33 percent.
Mental health
Division of Alcohol Intensive problems decreased
and Substance Abuse inpatient by 17 percent in
18-Month AdolescentAdolescents (nonhospital), major depressive
Outcomes Report outpatient syndromes and by 14
percent in suicide
attempts.
Physical health
problems decreased
in emergency room
visits.
Criminal activity
decreased in drug
dealing, theft, and
prostitution by 48
percent.
Abstinence was
achieved for 40
percent 3 months
after treatment.
Treatment Outcome
Evaluation: Youth Drug use prevalence
Admitted to decreased by 46
Residential Intensive percent for
Chemical DependencyYouth inpatient marijuana.
Treatment Under the (nonhospital)
Provisions of the Criminal activity
"Becca" Bill decreased in
selling drugs by 51
percent, breaking
and entering by 39
percent.
Abstinence occurred
for two-thirds of
the sample at 6
Adolescent Intensive months.
Treatment Outcome Adolescents inpatient
Study Report (nonhospital) Criminal activity
decreased fourfold
for felony arrests
after 1 year.
Adolescent Abstinence occurred
Treatment Outcome for 5 percent more
Study Report: court-referred
Six-Month Follow-up clients than
of Clients ReferredAdolescents others.
by the Juvenile referred by Intensive
Justice System, court or inpatient Criminal activity
Those Served by juvenile justice (nonhospital) decreased
Schools, as Well assystem significantly for
Those Whose Parents abstinent clients
Currently Abuse compared to
Substances relapsed clients.
(108394)
Table 1: Characteristics of SAMHSA's Major Drug Abuse
Treatment Studies 20
Table 2: States' Client Outcome Assessment Activities 22
Table 3: SAMHSA's Administrative Expenses, Fiscal Year 1999 Appropriation 31
Table 4: Selected SAMHSA Contracts for Technical Assistance
and Program Evaluation, Fiscal Year 1999, by Agency and
Program 32
Table 5: SAMHSA's Staffing Levels by Program, as of
December 1999 35
Figure 1: Percentage of SAMHSA's Drug Abuse Treatment
Expenditures for SAPT Block Grant and KDA Grant Programs,
Fiscal Year 1996 9
Figure 2: Percentage of Surveyed State Agencies' Total
Expenditures for Drug Abuse Treatment Services by
Funding Source, Fiscal Year 1996 10
Figure 3: Percent of SAPT Block Grant Expenditures for
Methadone Services, Fiscal Year 1996 12
1. The $3.2 billion represents funding from eight federal agencies: the
Federal Judiciary; the Departments of Health and Human Services, Veterans
Affairs, Defense, Education, Housing and Urban Development, and Justice; and
the Office of National Drug Control Policy.
2. SAMHSA's demonstration grant program was part of an effort to establish a
system for developing, documenting, and disseminating successful approaches
to prevent and treat substance abuse and mental illness. The KDA effort
emerged from the demonstration grant program and, according to SAMHSA
officials, uses more rigorous evaluation methods and focuses on developing
findings that can be adopted in other treatment settings.
3. Assessment of Performance Measures for Public Health, Substance Abuse,
and Mental Health , National Research Council, 1997.
4. In addition to state expenditures for drug abuse treatment, states spent
about $681 million in SAPT block grant awards to support alcohol treatment,
primary prevention, tuberculosis and HIV early intervention services, and
administration.
5. The remaining two states did not report the portion of SAPT block grant
funds spent on outpatient services.
6. Michigan and North Carolina state officials reported that they could not
provide information on methadone expenditures supported with SAPT block
grant funds because methadone expenditures could not be disaggregated from
other SAPT block grant expenditures for drug abuse treatment.
7. Drug Abuse Treatment: Data Limitations Affect the Accuracy of National
and State Estimates of Need (GAO/HEHS-98-229, Sept. 15, 1998).
8. Final results have not been reported on the effectiveness of selected
treatment practices for specific KDA programs.
9. These guidelines, which took effect for fiscal years ending on or after
June 30, 1997, include a review of a program's oversight, including
monitoring or other reviews conducted by oversight entities, current and
prior audit experience, and the inherent risk of the program.
10. The state's principal agency for drug abuse treatment is required to
maintain aggregate drug abuse treatment expenditures at a level that is not
less than the average level of such expenditures for the 2-year period
preceding the fiscal year for which the state is applying for the grant.
11. SAMHSA also funded the Alcohol and Drug Services Study, a national study
to obtain information on substance abuse treatment facilities and patients.
This study is a continuation of the Services Research Outcome Study and
provides more detailed information on the organization of the national
treatment system and the effectiveness and cost-effectiveness of treatment.
However, final results from this study are not yet available.
12. Georgia and New York did not provide results from their assessments;
Virginia officials stated that the results from their performance outcome
measurement system were ambiguous due to inconsistent data elements across
programs and problems with linking the information with the state's
management information system.
13. Washington law allows the use of Social Security numbers to track
clients; however, some states prohibit the use of these identifiers because
of privacy and access concerns.
14. The 19 states that applied and were selected to participate in TOPPS II
are Arizona, Arkansas, California, Connecticut, Illinois, Iowa, Kentucky,
Maryland, Massachusetts, Missouri, New Hampshire, New Jersey, New York,
Oklahoma, Rhode Island, Texas, Utah, Virginia, and Washington.
15. SAMHSA's core set of outcome measures also include alcohol use.
16. One expert we spoke with stated that it is also important to collect a
core set of clinical data at client admissions to help establish an
evaluation database and that such a database could be helpful in
standardizing treatment approaches and training of personnel in the drug
abuse treatment field.
*** End of document. ***