Substance Abuse and Violence Prevention: Multiple Youth Programs Raise
Questions of Efficiency and Effectiveness (Testimony, 06/24/97,
GAO/T-HEHS-97-166).

Pursuant to a congressional request, GAO discussed its work on federal
substance-abuse and violence-prevention programs for youth, focusing on:
(1) the information available about substance abuse and violence
prevention programs and the federal investment in them; (2) what is
known about the effectiveness of federally funded programs in reducing
youth substance abuse and violence; and (3) improving the federal effort
by focusing more on accountability and results.

GAO noted that: (1) its reviews have raised questions about the
efficiency and effectiveness of the federal effort in this area; (2) the
system that has developed, of multiple federal programs dispersed among
several agencies, has created potential for inefficient service as well
as difficulty for those trying to access the most appropriate services
and funding sources; (3) GAO identified 70 federal programs that could
have been used in fiscal year 1995 to provide substance abuse and
violence prevention services for youth; (4) these programs were located
in 13 federal departments or other federal entities and had
appropriations of about $2.4 billion; (5) state, county, and local
governments, as well as private sources, provided billions of dollars
for substance abuse prevention and treatment efforts for adults and
youth; (6) often, insufficient information exists on these programs'
performance; (7) although GAO identified some promising approaches for
preventing substance abuse and violence, its work suggests that
additional research is needed to further test these approaches'
effectiveness and their applicability to different populations in varied
settings; (8) a major information gap exists for federal decisionmakers
who need to know the accomplishments of these individual federal
programs and the combination of those programs; (9) the Government
Performance and Results Act of 1993 can move agencies toward a more
integrated approach to meeting common goals and a greater emphasis on
accountability and assessment of program results; and (10) this emphasis
will require agencies not only to better document federal programs'
progress toward achieving their goals of preventing substance abuse and
violence, but also to identify which service delivery approaches have
been effective and encourage greater use of the more effective models.

--------------------------- Indexing Terms -----------------------------

 REPORTNUM:  T-HEHS-97-166
     TITLE:  Substance Abuse and Violence Prevention: Multiple Youth 
             Programs Raise Questions of Efficiency and
             Effectiveness
      DATE:  06/24/97
   SUBJECT:  Aid for education
             Crime prevention
             Drug abuse
             Youth
             Education program evaluation
             Interagency relations
             Federal/state relations

             
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Cover
================================================================ COVER


Before the Subcommittee on Oversight and Investigations, Committee on
Education and the Workforce
House of Representatives

For Release on Delivery
Expected at 11:00 a.m.
Tuesday, June 24, 1997

SUBSTANCE ABUSE AND VIOLENCE
PREVENTION - MULTIPLE YOUTH
PROGRAMS RAISE QUESTIONS OF
EFFICIENCY AND EFFECTIVENESS

Statement of Carlotta C.  Joyner, Director
Education and Employment Issues
Health, Education, and Human Services Division

GAO/T-HEHS-97-166

GAO/HEHS-97-166T


(104894)


Abbreviations
=============================================================== ABBREV

  GPRA - Test
  ONDCP - Test
  HHS - Test
  NDATUS - Test
  SAMHSA - Test
  PPG - Test

SUBSTANCE ABUSE AND VIOLENCE
PREVENTION:  MULTIPLE YOUTH
PROGRAMS RAISE QUESTIONS OF
EFFICIENCY AND EFFECTIVENESS
============================================================ Chapter 0

Mr.  Chairman and Members of the Committee: 

I am pleased to be here today to discuss our work on federal
substance-abuse and violence-prevention programs for youths. 

Drug and alcohol abuse (substance abuse) and violence by youths are
serious problems confronting our nation.  After declining in the
eighties, drug use rates among school-age youths increased between
1992 and 1995 for more than 10 different types of drugs.  For
example, one study reported that the rate of marijuana use by eighth
grade students more than doubled--from about 7 to about 16
percent--and the rate for twelfth graders rose from about 22 to about
35 percent.  During this period, the rate of alcohol use remained
above 70 percent for twelfth graders.\1 The Congress found in 1994
that about 3 million thefts and violent crimes took place on or near
school campuses each year--more than 16,000 incidents per school
day.\2 About one in five high school students regularly carried a
firearm, knife, razor, club, or other weapon.  The federal
government, state and local governments, and private organizations
have all responded to these problems by establishing and funding a
wide range of programs and activities intended to reduce or prevent
youth substance abuse and violence. 

My testimony today, based on a number of studies we have issued, will
focus on (1) the information available about substance-abuse and
violence-prevention programs and the federal investment in them, (2)
what is known about the effectiveness of federally funded programs in
reducing youth substance abuse and violence, and (3) improving the
federal effort by focusing more on accountability and results.  (A
list of related GAO products appears at the end of this testimony.)
Although some of the data we present--for example, on programs and
their funding--are from 1994 and 1995, the issues we are addressing
have changed little since our work was done. 

In summary, our reviews have raised questions about the efficiency
and effectiveness of the federal effort in this area.  The system
that has developed--of multiple federal programs dispursed among
several agencies--has created the potential for inefficient service
as well as difficulty for those trying to access the most appropriate
services and funding sources.  For example, we identified 70 federal
programs that could have been used in fiscal year 1995 to provide
substance-abuse and/or violence-prevention services for youths. 
These programs were located in 13 federal departments or other
federal entities and had appropriations of about $2.4 billion.  In
addition, state, county, and local governments, as well as private
sources provided billions of dollars for substance-abuse prevention
and treatment efforts for adults and youths. 

Often, insufficient information exists on these programs'
performance.  Although we identified some promising approaches for
preventing substance abuse and violence, our work suggests that
additional research is needed to further test these approaches'
effectiveness and their applicability to different populations in
varied settings.  In addition, a major information gap exists for
federal decisionmakers who need to know the accomplishments of these
individual federal programs and the combination of those programs. 

The Government Performance and Results Act of 1993 (GPRA) can move
agencies toward a more integrated approach to meeting common goals
and a greater emphasis on accountability and assessment of program
results.  This emphasis will require agencies not only to better
document federal programs' progress toward achieving their goals of
preventing substance abuse and violence, but also to identify which
service delivery approaches have been effective and encourage greater
use of more effective models. 


--------------------
\1 Monitoring the Future, National Institutes of Health, National
Institute on Drug Abuse (Rockville, Md.:  1996). 

\2 20 U.S.C.  7102 (3). 


   BACKGROUND
---------------------------------------------------------- Chapter 0:1

Stemming the tide of youth drug use and violence is a high priority
on the national policy agenda.  For example, one of the five goals of
the Office of National Drug Control Policy (ONDCP), created by the
Congress in 1988 to lead the nation's war on drugs, is to "educate
and enable America's youth to reject illegal drugs as well as alcohol
and tobacco."\3 In addition, one of the National Education Goals,
adopted by the Congress in 1994, is that "by the year 2000, all
schools in America will be free of drugs, violence, and the
unauthorized presence of firearms and alcohol, and will offer a
disciplined environment that is conducive to learning."\4 In fiscal
year 1994, $1.8 billion, 40 percent of the $4.4 billion federal
budget authority for substance-abuse prevention and treatment, was
targeted to prevention activities for adults and youths.\5


--------------------
\3 National Drug Control Strategy, 1997, ONDCP (Washington, D.C.). 

\4 20 U.S.C.  5812 (7). 

\5 In our report, Drug and Alcohol Abuse:  Billions Spent Annually
for Treatment and Prevention Activities (GAO/HEHS-97-12, Oct.  8,
1996), we noted that ONDCP estimated total budget authority of $4.7
billion for fiscal year 1996, but we did not analyze the percentage
that was authorized for treatment compared with prevention. 


      PREVENTING SUBSTANCE ABUSE
-------------------------------------------------------- Chapter 0:1.1

The major goals of substance-abuse prevention programs are preventing
or eliminating drug and alcohol abuse and averting substance abuse-
related problems.  Prevention activities vary and are directed at
different groups and delivered in multiple settings.  For example,
activities may include

  -- providing information and education to increase knowledge of
     substance abuse and alternative drug-free lifestyles;

  -- teaching skills to resist drug and alcohol influences, solve
     problems, and make decisions;

  -- developing interventions to control the sale and distribution of
     illegal drugs; and

  -- encouraging communities to implement responses to drug and
     alcohol use. 

Activities may be directed toward

  -- the general population to alter social, psychological, and
     environmental factors that may inflence the prevalence and
     outcomes at the community level;

  -- individuals or subgroups at risk of developing substance abuse
     behaviors to reduce risk factors\6 and enhance protective
     factors\7 related to the onset of use and the progression to
     abuse and dependence; or

  -- individuals who use one or more drugs but who do not yet meet
     diagnostic criteria for a substance abuse disorder to interrupt
     the progression from use to abuse, addiction, and social
     dysfunction. 

Service delivery settings may include the classroom, peer support
groups, the home, and the community, or a combination of these. 


--------------------
\6 Reducing risk factors focuses on trying to lessen the negative
effect of factors that impinge on one's life that have been shown or
theorized to relate to drug and alcohol use.  These factors include
availability of drugs and alcohol, community norms favorable to drug
and alcohol use, extreme economic deprivation, family history of
problems with use, favorable parental attitudes and involvement in
problem use, early and persistent antisocial behavior, academic
failure, alienation and rebellion, and friends who engage in problem
behavior. 

\7 Enhancement of protective factors focuses on increasing an
individual's resilience in dealing with potentially high-risk
situations (such as dysfunctional families, schools, and
communities).  Researchers in substance abuse prevention have
hypothesized that more resilient individuals are less likely to
engage in drug use.  Optimism, empathy, insight, intellectual
competence, self-esteem, direction or mission, and determination and
perseverance are seven major factors affecting youths' resilience. 
The coping or life skills associated with these seven factors are
emotional management skills, interpersonal social skills,
intrapersonal reflective skills, academic and job skills, ability to
restore self-esteem, planning and life skills, and problem-solving
ability. 


      PREVENTING VIOLENCE
-------------------------------------------------------- Chapter 0:1.2

Schools use a wide variety of educational and noneducational
approaches and programs to address violence.  Many school-based
violence-prevention programs operate under the premise that violence
is a learned behavior.  In general, these programs focus on primary
prevention; that is, they seek to prevent violence before it occurs. 
Although school-based violence-
prevention programs and strategies vary, most fall within three broad
categories: 

  -- Educational and curricula-based programs:  These programs seek
     to teach students the skills to manage their behavior and
     resolve conflict nonviolently.  Examples are programs that focus
     on conflict resolution or gang aversion. 

  -- Environmental modification:  These programs focus on either the
     social or physical environment.  Examples include after-school
     recreational and academic activities and metal detectors and
     gates limiting access to building entrances and exits. 

  -- School organization and management:  These programs focus on
     establishing school discipline policies and procedures governing
     student behavior, creating alternative schools, and developing
     cooperative relationships with police and other government
     agencies. 


   PREVENTION EFFORTS SPAN MANY
   AGENCIES AND PROGRAMS
---------------------------------------------------------- Chapter 0:2

Multiple sources currently fund a wide variety of substance-abuse
prevention and violence-prevention programs.  The federal government,
while a major investor in prevention programs, is just one of several
contributors.  State and local governments, as well as the private
sector, also contribute to the billions spent annually on prevention
efforts.  The current array of prevention services, however, does not
constitute an integrated approach to substance abuse and violence
problems, raising questions about overlapping services and
duplication created by these many programs. 


      MULTIPLE FEDERAL PROGRAMS
      WITH MANY SIMILAR SERVICES
-------------------------------------------------------- Chapter 0:2.1

The federal government funds a wide array of programs to prevent
substance abuse and violence.  For youths, many of these services are
provided through programs targeted to delinquent youths or youths
considered at risk for delinquency or drug use.\8

In our 1996 report on delinquent and at-risk youths, we identified
more than 131 programs administered by 16 federal departments and
other agencies.\9 At that time, we estimated that the amount of the
federal appropriations for these programs dedicated to at-risk and
delinquent youths exceeded more than $4 billion in fiscal year 1995. 

Further analysis showed that 70 of the 131 programs were authorized
to provide either substance-abuse prevention or violence-prevention
services or both to the youths they served (see app.  I).\10 For
example, 34 of these programs may provide both types of prevention
services.  The 70 prevention programs we identified are administered
by 10 federal agencies, one presidential council, and a federal
foundation.  The Departments of Health and Human Services (HHS),
Justice, and Education administer 48 of these programs--nearly 70
percent of all the programs.  The fiscal year 1995 appropriations for
the prevention programs for youths in these three departments totaled
about $1 billion, about 42 percent of the total federal appropriation
of about $2.4 billion for all 70 programs.\11

Although we have not fully examined these multiple programs, the
implications of having multiple, unintegrated substance-abuse and
violence-prevention programs might be similar to those for employment
training programs--an area we have examined.  In fiscal year 1995, we
identified 163 federal employment training programs disbursed among
15 departments and agencies.  We recently concluded that
consolidating these programs could probably reduce the cost of
providing job training services because of the efficiencies achieved
by eliminating duplicative administrative activities.  Furthermore,
consolidating similar programs could improve opportunities to
increase service delivery effectiveness.\12


--------------------
\8 The term "at risk" can have different meanings in different
contexts.  We are using the term in a broad sense to refer to youths
who, due to certain characteristics or experiences, are statistically
more likely than other youths to encounter certain problems--legal,
social, financial, educational, emotional, and health--in the future. 

\9 At-Risk and Delinquent Youth:  Multiple Federal Programs Raise
Efficiency Questions (GAO/HEHS-96-34, Mar.  6, 1996). 

\10 Our original analysis focused on 17 types of services or
activities that programs could provide to at-risk or delinquent
youths.  Of those, we identified five that focused on substance-abuse
prevention or violence prevention:  conflict resolution,
crime/violence intervention, focused activities (activities for
preventing juvenile delinquency by offering positive, alternative
ways for youths to spend their time, such as recreation and sports),
gang intervention, and substance-abuse intervention.  For the
analysis presented in this testimony, we did not update information
about the appropriations. 

\11 This is a conservative estimate because it is based on
information for only 61 of the 70 programs; for the remaining 9
programs, officials were unable to estimate the portion of total
appropriations that was dedicated to youths (ages 5 through 24). 

\12 Department of Labor:  Challenges in Ensuring Workforce
Development and Worker Protection (GAO/T-HEHS-97-85, Mar.  6, 1997). 


      CONTRIBUTIONS FROM
      NONFEDERAL SOURCES
-------------------------------------------------------- Chapter 0:2.2

State, county, and local governments also help fund substance-abuse
and violence-prevention programs.  In fiscal year 1994, they reported
spending $1.6 billion in addition to the $4.4 billion federal budget
authority for substance-abuse prevention and treatment for adults and
youths.  Forty percent of the federal funds and 12 percent of the
state, county, and local funds were targeted to prevention services. 
Total spending by state and local governments, however, probably does
exceed these reported expenditures.\13

Comprehensive data on private funding of substance-abuse prevention
activities over time are sparse.  For example, the National Drug and
Alcoholism Treatment Unit Survey (NDATUS), which compiled private
contributions from various sources, focused on treatment only.\14
Data on private donations from foundations, however, show that the
top 25 contributors awarded $39.4 million in grants for
substance-abuse treatment and prevention programs for adults and
youths during 1993 and 1994, the latest years for which grant data
were available at the time of our report.  The grants ranged from
$306,342 to about $18.5 million.  These grants were provided to
nonprofit organizations in the United States and abroad for
substance-abuse treatment and prevention programs, including
counseling, education, residential care facilities, halfway houses,
support groups, family services, community programs, and services for
children of drug-dependent parents.  Grants were also awarded for
medical research on substance abuse and media projects on
substance-abuse prevention.  Population groups receiving the largest
grant amounts were alcohol or drug abusers, children and youths,
women and girls, economically disadvantaged individuals, offenders or
ex-offenders, and minorities. 


--------------------
\13 GAO/HEHS-97-12, Oct.  8, 1996. 

\14 Sponsored by the Substance Abuse and Mental Health Services
Administration's (SAMHSA) Office of Applied Studies, NDATUS is a
census of substance-abuse treatment units in the United States and
the U.S.  territories. 


   EFFECTIVENESS OF PREVENTION
   PROGRAMS
---------------------------------------------------------- Chapter 0:3

Our previous work has identified promising approaches for both
substance-abuse prevention and violence prevention.  Evaluation
research provides some information about effective program models and
their outcomes.  But often less information is available on the
effectiveness of individual programs funded at the national, state,
and local levels by the federal government or by sets of such
programs addressing similar goals. 


      PROMISING PROGRAM MODELS
      IDENTIFIED
-------------------------------------------------------- Chapter 0:3.1

Research on the effectiveness of substance-abuse and
violence-prevention programs has identified promising approaches in
both areas.  Our recent review of the literature on the effectiveness
of substance-abuse prevention programs identified two promising
approaches for school-age youths.\15 The first approach--referred to
as the psychosocial approach--
emphasizes improving individuals' drug-resistance skills and generic
problem-solving/decision-making skills and modifying attitudes and
norms that encourage drug use.  The second approach--the
comprehensive approach--involves the coordinated use of multiple
societal institutions, such as family, community, and schools, for
delivering prevention programs.  Both approaches have reduced student
drug use as well as strengthened individuals' ability to resist drugs
in both short- and longer term programs.\16 Although other
approaches, such as information dissemination, affective education,
and alternatives to drug use, have been used in previous programs,
they have not shown consistent effectiveness when used individually. 
They have been included, however, in promising comprehensive
approaches to prevention. 

In our 1995 report on school safety, we described the characteristics
of promising school-based violence-prevention programs.\17 These
characteristics are (1) a comprehensive approach, (2) an early start
and long-term commitment, (3) strong leadership and disciplinary
policies, (4) staff development, (5) parental involvement, (6)
interagency partnerships and community linkages, and (7) a culturally
sensitive and developmentally appropriate approach.  For example,
teaching students early about making positive choices and linking
school-based programs to community groups, such as law enforcement or
service agencies, are approaches used by promising programs. 

We also identified four programs that have received national
recognition for their innovative approach to addressing school
violence:  the Anaheim Union School District program in California,
which stresses school management and order issues; the Paramount,
California, program in which schools use an anti-gang curriculum to
reduce gang membership among students who participated in the
program; a Dayton, Ohio, program that provides students with social
skills and anger-management training; and a New York City program
that uses conflict-resolution and peer-
mediation training to reduce student fighting. 

Preliminary evaluations of these programs concluded that they showed
initial signs of success because student participants' attitudes and
behaviors had changed.  Reported participant changes included (1) new
attitudes toward violence and gang membership; (2) less disruptive
behavior, including fewer fights; and (3) less contact with the
criminal justice system.  For example, public health officials have
regarded New York City's Resolving Conflict Creatively Program as one
of the most promising violence-prevention programs.  Early evaluation
results of this program showed that teachers observed less student
name calling and fewer verbal put-downs by students.  Teachers also
agreed that the mediation program has helped students take more
responsibility for solving their own problems. 


--------------------
\15 Drug Control:  Observations on Elements of the Federal Drug
Control Strategy (GAO/GGD-97-42, Mar.  14, 1997). 

\16 Some of the most notable programs include (1) the Life Skills
Training Prevention Program (using a psychosocial approach), which
showed that 44 percent less intervention participants reported use of
three drugs over a specified period of time, as compared with control
group participants, and (2) the Midwestern Prevention Project (using
a comprehensive approach), also known as Project Star or I-Star,
which showed a 20- to 40-percent net reduction in the use of two
drugs by school-age youths over a 3-year period. 

\17 School Safety:  Promising Initiatives for Addressing School
Violence (GAO/HEHS-95-106, Apr.  25, 1995). 


      ADDITIONAL RESEARCH NEEDED
      ON EFFECTIVENESS OF PROGRAM
      APPROACHES
-------------------------------------------------------- Chapter 0:3.2

While our work has identified promising approaches, more and better
evaluation research is needed on program effectiveness.  For example,
regardless of the early positive results of certain substance-abuse
prevention approaches, experts suggest that additional research is
needed to better identify and understand the elements of effective
prevention.  They say substantiating early program results through
further research and evaluation is important to advancing promising
substance-abuse prevention approaches.  Examples of useful
initiatives for future research include determining the combination
of approaches that yields the most significant outcome results and
assessing the approaches that work best for different population
groups. 

We reached similar conclusions about violence-prevention programs. 
While the early results of violence-prevention programs proved a
useful starting point, a general consensus exists that the
methodological rigor of these studies must be improved to determine
program effectiveness.  To improve the usefulness of future
evaluations, designing stronger impact or effectiveness studies
should be emphasized.  Design issues requiring particular attention
include sampling techniques, longitudinal assessment, random
assignment, and collection of data on impact and outcome measures. 

Conducting such evaluations, according to officials we interviewed,
depends on obtaining grants or private funds specifically for that
purpose.  Fortunately, some agencies have now begun funding impact
evaluations to study the effectiveness of specific school-based
interventions.  For example, the Centers for Disease Control and
Prevention, the National Institute of Justice, and the National
Institute of Mental Health awarded 26 grants totaling approximately
$28 million for this purpose during fiscal years 1993 and 1994. 


      INFORMATION GENERALLY
      LACKING ABOUT OVERALL
      RESULTS OF FEDERAL PROGRAMS
-------------------------------------------------------- Chapter 0:3.3

From a decision-making standpoint, what is needed--but often not
available--is information about the overall effectiveness of a
particular program.  That is, to what extent are individual programs,
such as the Safe and Drug-Free Schools and Communities Act of 1994
program, achieving the expected results?  Information is needed about
such programs because decisions about appropriate funding levels and
sources are made at the program level.  In addition, with accurate
information about the overall results of the federal programs
addressing similar goals, such as preventing substance abuse and
violence, more effective use could be made of those funds.  First,
inefficiencies in the use of funds, such as those resulting from
overlapping and duplicative programs, could be reduced through
retargeting or combining programs.  Second, policymakers could better
ensure that the activities funded--in this case, the individual
program models used--are the ones most likely to achieve program
goals. 


   INCREASING EMPHASIS ON
   ACCOUNTABILITY AND PROGRAM
   RESULTS
---------------------------------------------------------- Chapter 0:4

GPRA can be a useful mechanism for the Congress and federal agencies
to improve the combined federal effort against substance abuse and
violence among youths.  GPRA requires agencies to ask fundamental
questions about their missions, their goals and objectives for
achieving those missions, how they will measure their performance,
and how they will use performance measurement information to improve
their efforts.  It forces federal agencies to shift the focus from
such traditional concerns as staffing and activity levels to a
single, overriding issue:  results. 

Specifically, GPRA directs agencies to consult with the Congress,
obtain the views of other stakeholders, and clearly define their
missions.  It also requires agencies to establish long-term strategic
goals as well as annual performance goals linked to the strategic
goals.  Agencies must then measure their performance according to
their goals and report to the President and the Congress on their
success.  In addition to ongoing performance monitoring, agencies are
expected to identify performance gaps in their programs and to use
information from evaluation studies to improve programs. 

GPRA requires that federal agencies develop strategic plans covering
at least 5 years and submit them to the Congress and the Office of
Management and Budget no later than September 30, 1997.  These plans
must identify the agencies' long-term strategic goals and describe
how the agencies intend to meet these goals through their activities
and resources.  The plans are expected to reflect coordination with
other federal agencies that are trying to achieve similar strategic
goals or have activities or functions similar to theirs.  Beginning
with fiscal year 1999, federal agencies are to use their strategic
plans to prepare annual performance plans.  These performance plans
are to include annual goals linked to the activities described in
budget presentations as well as the indicators the agency will use to
measure performance according to the results-oriented goals. 
Agencies are subsequently to report each year on the extent to which
they meet their goals, provide an explanation regarding any goals
they did not meet, and describe the actions needed to meet any unmet
goals. 

For substance-abuse and violence-prevention programs, this shift to a
focus on results can help bridge the gap between accurate data about
effective program models and the performance of individual federal
programs.  For example, current research has identified aspects of
effective substance-abuse prevention programs and characteristics of
promising approaches for violence-prevention programs.  This
research, however, often consists of one-time efforts, and the extent
to which these studies influence other programs' design and service
delivery is uncertain.  GPRA, on the other hand, provides an
incentive for agency and program personnel to systematically assess
what is working in their programs and expand or replicate those
practices.  GPRA also provides an early warning system for
identifying goals and objectives that are not being met so that
agency and program staff can replace ineffective practices with
effective ones. 

Measuring how well programs are working can present a major
challenge, however, especially when funds are distributed through
block grants--as is the case with many of the programs we identified. 
For example, most of the dollars distributed by HHS' SAMHSA in fiscal
year 1996--including the $1.2 billion to states for substance-abuse
prevention and treatment services--was distributed through block
grants.\18 The agency faces the challenge of balancing the
flexibility it affords states to set priorities on the basis of local
need with its own need to hold the states accountable for achieving
SAMHSA's goals.  Recognizing this challenge, HHS is transforming its
SAMHSA block grants into Performance Partnership Grants (PPG).  Under
PPGs, the states and federal governments will negotiate an
arrangement that identifies specific objectives and performance
measures regarding outcomes, processes, and these outcomes' capacity
to be reached in 3 to 5 years.  This appears to be a promising
strategy because it gives states more control over their funding
decisions while encouraging them to accept greater accountability for
results. 


--------------------
\18 Substance Abuse and Mental Health:  Reauthorization Issues Facing
the Substance Abuse and Mental Health Services Administration
(GAO/T-HEHS-97-135, May 22, 1997). 


   CONCLUSIONS
---------------------------------------------------------- Chapter 0:5

The federal investment in youth substance-abuse and
violence-prevention programs is intended to help America's youths
avoid the harmful consequences, to themselves and society, of
substance abuse and violent behavior.  Although some of these
individual federally funded efforts have shown value, concern still
exists about the overall efficient use of federal funds and the
effectiveness of the services they provide.  An integrated,
coordinated federal effort is lacking.  Such an effort would consider
the substantial investment by other levels of government and the
private sector and have clear accountability for results.  Better
information is needed about which program approaches are most
effective with which groups of youths in preventing substance abuse
and violence.  We also need such information to better link results
to overall federal funding for programs.  GPRA is an important tool
for bridging this gap between knowledge about individual program
approaches and federal funding for programs because it provides the
needed accountability and an incentive for agencies to set measurable
goals for their programs and to periodically assess progress toward
those goals. 


-------------------------------------------------------- Chapter 0:5.1

Mr.  Chairman, this concludes my prepared statement.  I would be
pleased to respond to any questions you or members of the
Subcommittee may have. 


FEDERAL SUBSTANCE-ABUSE PREVENTION
AND VIOLENCE-PREVENTION PROGRAMS
FOR YOUTHS
=========================================================== Appendix I

                              (Dollars in millions)

                                        Type of prevention assistance for which
                                                  funds are available
                                       -----------------------------------------
                          Estimate of
                          federal
                          funding for
                          youths       Substance-
                          during FY    abuse        Violence
Agency and program        1995         prevention   prevention   Both
------------------------  -----------  -----------  -----------  ---------------
Corporation for National and Community Service (three programs)
--------------------------------------------------------------------------------
Foster Grandparent        $67.8        X
Program

Retired and Senior        35.7                                   X
Volunteer Program

Volunteers in Service to  13.7                                   X
America

Subtotal                  $117.2


Department of Agriculture (four programs)
--------------------------------------------------------------------------------
4-H Youth Development     63.0                      X
Education--Cooperative
Extension System

Children, Youth, and      10.0                      X
Families at Risk
Initiative--Cooperative
Extension System

Partnerships Against      Not                                    X
Violence Network          available

Youth Conservation Corps  3.0                       X

Subtotal                  $76.0


Department of Defense (two programs)
--------------------------------------------------------------------------------
Child Development and     8.0                                    X
Youth Programs--"At-
Risk" Youth Program

Community Outreach Pilot  8.0          X
Program

Subtotal                  $16.0


Department of Education (five programs)
--------------------------------------------------------------------------------
Civic Education Program   4.5                       X

Drug-Free Schools and     25.0                                   X
Communities--National
Programs

Family and Community      0.0                       X
Endeavor Schools Grant
Program

Safe and Drug-Free        441.0                                  X
Schools, Part A, Subpart
1, State Grants for Drug
and Violence Prevention

School Dropout            12.0                      X
Demonstration Assistance
Program

Subtotal                  $482.5


Department of Health and Human Services (29 programs)
--------------------------------------------------------------------------------
Center for Substance      2.3          X
Abuse Prevention--
Public Education/
Dissemination

Community Prevention      Not                                    X
Coalitions Demonstration  available
Grant Program

Community Schools Youth   10.0                                   X
Services and Supervision
Program

Demonstration Grant       2.0                       X
Program for Residential
Treatment for Women and
Their Children

Demonstration             0.0                                    X
Partnership Program

Demonstration Programs    65.2         X
for High Risk Youth

Drug Abuse Prevention     14.5         X
for Runaway and Homeless
Youth

Emergency Community       Not                       X
Services Homeless Grant   available
Program

Family and Community      5.9                                    X
Violence Prevention
Program

Family Support Center     7.3                                    X
and Gateway
Demonstration Programs

Health Care for the       Not          X
Homeless Program          available

Health Services for       9.5                                    X
Residents of Public
Housing

Indian Health Service--   66.1         X
Alcohol and Substance
Abuse Programs

Indian Youth Grant        0.5                                    X
Program

Injury Prevention and     22.2                      X
Control Research and
State Grant Projects

Maternal and Child        Not                       X
Health Block Grant        available
Services Program

Maternal and Child        3.4                                    X
Health Block Grant
Services Program--
Special Projects of
Regional and National
Significance

Migrant Health Centers    Not          X
                          available

National Institute of     20.3         X
Alcohol Abuse and
Alcoholism--Research
Programs

National Institute on     6.0          X
Drug Abuse--Research
Programs

National Youth Sports     12.0                                   X
Program

Native American Programs  Not                       X
                          available

Runaway and Homeless      40.5                      X
Youth Programs--Basic
Centers

Service Grant Program     1.3                                    X
for Residential
Treatment for Pregnant
and Postpartum Women

Social Services Block     Not          X
Grant                     available

Substance Abuse           Not          X
Prevention and Treatment  available
Block Grant

Urban Indian Health       5.8          X
Program

Youth Initiatives/Youth   10.5                                   X
Gangs

Youth Risk Behavior       1.4          X
Surveillance System

Subtotal                  $306.7


Department of Housing and Urban Development (four programs)
--------------------------------------------------------------------------------
4-H After-School          3.5                                    X
Program/Demonstration

Youth Apprenticeship      0.4                       X

Youth Development         10.0                                   X
Initiative

Youth Sports/Public and   13.9                                   X
Indian Housing Drug
Elimination Program

Subtotal                  $27.8


Department of the Interior (one program)
--------------------------------------------------------------------------------
Indian Child Welfare Act  23.8                      X
(Title II Grants)

Subtotal                  $23.8


Department of Justice (14 programs)
--------------------------------------------------------------------------------
Boot Camps, Part H        0.0                                    X

Children's Justice Act    0.0                       X
Discretionary Grants for
Native American Indian
Tribes

Community Outreach        0.3                                    X
Program

Community Relations       10.0                      X
Service Initiatives

Edward Byrne Memorial     28.8                                   X
State and Local Law
Enforcement Assistance
Programs--Discretionary
Grant

Edward Byrne Memorial     48.5                                   X
State and Local Law
Enforcement Assistance
Programs--Formula Grant

Gang-Free Schools and     10.0                                   X
Communities--Community-
Based Gang Prevention

Juvenile Justice and      70.0                                   X
Delinquency Prevention-
-Allocation to States
(State Formula Grants)
Part B

Juvenile Justice and      4.0                       X
Delinquency Prevention-
-Juvenile Mentoring,
Part G

Juvenile Justice and      25.0                                   X
Delinquency Prevention
National Programs--
Discretionary Grants,
Part C

Public Education on Drug  0.7                                    X
Abuse

Title II: Part A--        0.2                                    X
Concentration of Federal
Efforts

Title V--Incentive        20.0                                   X
Grants for Local
Delinquency Prevention
Programs

Weed and Seed Program     Not                                    X
Fund                      available

Subtotal                  $217.5


Department of Labor (one program)
--------------------------------------------------------------------------------
Job Training Partnership  1,099.5                                X
Act--Job Corps

Subtotal                  $1,099.5


Department of Transportation (one program)
--------------------------------------------------------------------------------
Youth Impaired Driving    1.4                                    X
Projects

Subtotal                  $1.4


Department of Treasury (one program)
--------------------------------------------------------------------------------
Gang Resistance           16.2                      X
Education and Training
Projects

Subtotal                  $16.2


National Foundation on the Arts and Humanities (four programs)
--------------------------------------------------------------------------------
Promotion of the Arts--   0.4                       X
Arts for Youth

Promotion of the Arts--   5.8                       X
Arts in Education-Art
Corps

Promotion of the Arts--   0.3                       X
Expansion Arts--Arts
Education Initiative

Promotion of the Arts--   2.7                       X
State and Regional
Program

Subtotal                  $9.2


President's Crime Prevention Council (one program)
--------------------------------------------------------------------------------
President's Crime         1.5                                    X
Prevention Council

Subtotal                  $1.5

Total                     $2,395.3
--------------------------------------------------------------------------------
RELATED GAO PRODUCTS

The Government Performance and Results Act:  1997 Governmentwide
Implementation Will Be Uneven (GAO/GGD-97-109, June 2, 1997). 

Substance Abuse and Mental Health:  Reauthorization Issues Facing the
Substance Abuse and Mental Health Services Administration
(GAO/T-HEHS-97-135, May 22, 1997). 

Agencies' Strategic Plans Under GPRA:  Key Questions to Facilitate
Congressional Review (GAO/GGD-10.1.16, May 1997). 

Drug Control:  Observations on Elements of the Federal Drug Control
Strategy (GAO/GGD-97-42, Mar.  14, 1997). 

Drug and Alcohol Abuse:  Billions Spent Annually for Treatment and
Prevention Activities (GAO/HEHS-97-12, Oct.  8, 1996). 

Executive Guide:  Effectively Implementing the Government Performance
and Results Act (GAO/GGD-96-118, June 1, 1996). 

At-Risk and Delinquent Youth:  Multiple Federal Programs Raise
Efficiency Questions (GAO/HEHS-96-34, Mar.  6, 1996). 

Managing for Results:  Achieving GPRA's Objectives Requires Strong
Congressional Role (GAO/T-GGD-96-79, Mar.  6, 1996). 

School Safety:  Promising Initiatives for Addressing School Violence
(GAO/HEHS-95-106, Apr.  25, 1995). 

Drug Use Among Youth:  No Simple Answers to Guide Prevention
(GAO/HRD-94-24, Dec.  29, 1993). 

Adolescent Drug Use Prevention:  Common Features of Promising
Community Programs (GAO/PEMD-92-2, Jan.  16, 1992). 

Drug Education:  School-Based Programs Seen as Useful but Impact
Unknown (GAO/HRD-91-27, Nov.  28, 1990). 


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