FY 2005 Government Performance and Results Act (GPRA)

IV. PERFORMANCE PLAN AND REPORT
Substance Abuse Prevention

Substance abuse prevention programs included in this report are:

8. State Incentive Grants
9. Centers for the Application of Prevention Technologies (CAPT)
10. Substance Abuse Prevention and HIV Prevention in Minority Communities
11. Synar Amendment
12. 20% Substance Abuse Prevention and Treatment Block Grant Prevention Set-Aside

Prevention Framework Priority Area

8. State Incentive Grants (Basic SIGs Program¹)

Full Cost Table

8. State Incentive Grants (SIGs)	2003	2004	2005
Incorporates:
8.1 (40%)	$25.91	$14.24	$8.32
8.2 (60%)	$38.87	$21.36	$12.5
Total Full Cost Funding ($'s in Millions)	$64.78	$35.61	$20.80

*Numbers requested on 1/20/04

Program Description and Context

State Incentive Grants (SIGs) are CSAP's Targeted Capacity Expansion mechanism for building prevention capacity. The SIG program improves States' capacity to address prevention needs in the States. These systems enable States to better utilize prevention resources, implement effective prevention program models, and coordinate prevention among different agencies and funding streams. Eighty-five percent of program funds provided under the SIG grants are channeled to local community-based and faith-based organizations, community partnerships and coalitions, workplace-based prevention and early intervention programs, local governments, schools, and school districts. A total of 44 States have received SIG awards as of FY 2003.

The SIG program is improving prevention programming in communities across the country by supporting the implementation of a wide array of programs that have been shown to be effective in preventing youth substance abuse. In 2004, CSAP will fund an estimated 1,300 community-based organizations to implement or enhance substance abuse prevention programs. It is estimated that these supported organizations implement more than 3,250 local prevention programs. An indicator of success is that the first five SIG States continue to support the prevention programs initiated under the SIG, even though SIG funding has ended. In addition, many States are better using their Block Grant funds by requiring that these funds also support science-based prevention programs.

Performance Analysis

Measure 1: Increase State collaboration rating in the following areas: (a) prevention service delivery (b) prevention legislation/ policies and (c) use of prevention related resources

This measure tracks performance in three important domains. A specific scaling instrument is used to score the collaboration from 1 - 100 percent. For FY 2002, the SIG program continued to exceed its target in two of the three collaboration measures, prevention legislation/policies and use of prevention resources. The target for prevention service delivery was not met, largely because a number of newer SIGs were included in the measure, and collaboration on service delivery requires a great deal of coordination and planning which newer programs require more time to achieve. To improve performance, CSAP will be working closely with the States to improve collaboration efforts in the ongoing implementation of the SIG, and raising awareness of the importance of improved collaboration and coordination that are the cornerstones of the systems change intended by the SIG.

Measure 2: Increase the number of science-based programs being implemented by local sub-recipients in SIG states

This measure is important in increasing the effectiveness of prevention services. In FY 2002, this measure was exceeded. FY 2004 and 2005 targets have been revised based on actual data on the number of subrecipients funded.

In addition to these results on the measures, SIG States have been successful in identifying and leveraging prevention funds. Preliminary information shows that some SIG States have coordinated up to 10 times the federal grant amount through matching funds.

9. Centers for the Application of Prevention Technologies (CAPTs)

Performance Goals (Capacity)	Targets	Actual Performance	Reference
1. Increase the number of persons served (E)	FY 06: TBR 12/05 FY05: TBR 12/04 FY04: 12,000 (See narrative) FY03: Additional data being collected to set target FY 02: Baseline	FY 06: TBR 12/06 FY 05 TBR 12/05 FY 04: TBR 12/04 FY 03: 20,275 FY 02: 18,207 (revised to include additional data)	HHS SP-1
2. Increase the number of systemic change outcomes in prevention systems. (O) (Replaces Measure 3 from FY 2003 GPRA plan)	FY 06: TBR 12/05 FY05: TBR 12/04 FY04: TBR 30 (See narrative) FY03: Additional data being collected to set target FY 02: Baseline	FY 06: TBR 12/06 FY 05 TBR 12/05 FY 04: TBR 12/04 FY 03: 48 FY 02: 79
Total Funding:	2005: $11,800 2004: $11,104 2003: $10,484

Full Cost Table

9. Centers for the Application of Prevention Technologies (CAPTs) Incorporates:	2003	2004	2005
9.2 (50%)	$5.9	$6.3	$6.7
9.1 (50%)	$5.9	$6.3	$6.7
Total Full Cost Funding ($'s in Millions)	$11.84	$12.63	$13.44

Program Description and Context

The Centers for the Application of Prevention Technologies (CAPTs) are SAMHSA/CSAP's primary knowledge application program supporting CSAP's mission to bring effective substance abuse prevention to every community. The CAPTs form the cornerstone of CSAP's efforts to move prevention science into effective services. The CAPTs, through five regional technical assistance centers, serve State Incentive Grantees and their local sub-recipients, other States, many Tribes and US Territories, all 47 recipients of the US Department of Education Grants to reduce alcohol abuse grantees, and community-based organizations and coalitions. In FY 2004, the CAPTs will also serve Weed and Seed grantees for the U.S Department of Justice. The CAPTs promote state-of-the-art prevention technologies through three core strategies: 1) Establishment of a technical assistance network using local experts for each region, 2) Development of training activities, and 3) Innovative use of communication media (e.g., teleconferencing, online events, video conferencing, and Web-based support).

In FY 2003, the CAPT program was converted from the cooperative agreement funding mechanism to contracts. The program is currently in a transition period to establish a greater degree of consistency across the CAPT regions.

The CAPT data collection system has undergone revisions implemented in FY 2002 and operational for 2003 GPRA measures. Baseline data for the revised measures is reported using the new system. The new national CAPT data collection system reflects a number of conclusions about the most accurate and effective way to assess the work of the CAPTs. For example, the Technical Assistance (TA) database now focuses on overall TA services provided, and includes selected client ratings (satisfaction with and utility of CAPT service provided). The Event database now allows an examination of participant ratings (satisfaction with event and likelihood of using the information received). The new Systemic Outcomes database captures information on substantive changes that are related to the work of the CAPTs. This redesigned data system represents a significant commitment to tracking the impact of CAPT work.

Performance Analysis

Measure 1: Increase the number of persons served to build state/community level prevention capacity

The number of persons served in FY 2003 was 20,275, 11% higher than the previous year. As of January 2004, only 3 of the 5 contracts for regional CAPTs have been awarded. FY 2004 targets have been set lower because they are based on 3 rather than 5 CAPT centers, and to account for the transition from cooperative agreements to contracts.

Measure 2: Increase number of systemic change outcomes in prevention systems at the local, county, regional, state, national, or multi-national level.

In FY 2003, there were 48 additional systemic outcomes, representing a decrease from the baseline year. This short-term decrease is to be expected because, once system changes are implemented, these changes are refined and modified over time to obtain the desired outcome. Efforts are then devoted to maintaining and managing the implementation of the change. In addition, the number of newly funded SIGs has decreased, and the new SIG enhancements have only just been funded. Thus, it is more likely that increases in systems outcomes will occur in the future when the newly funded SIGs are able to document the CAPT's contributions to their systems.

HIV/AIDS and Hepatitis C Priority Area
10. Substance Abuse Prevention and HIV Prevention in Minority Communities

Performance Goals (Capacity)	Targets	Actual Performance	Reference
1. Increase perception of risk for substance use/abuse for youth (O)	FY 06: Cohort 2 ended. See narrative for discussion of data collection for Cohort 3. FY 05: TBR 9/04 FY 04: See narrative for discussion of data collection issues FY 03 Establish new baseline	FY 06: Cohort 2 ended. See narrative for discussion of data collection for Cohort 3. FY 05: TBR 12/05 FY 04: See narrative for discussion of data collection issues FY 03: TBR 5/04 See narrative for discussion of data collection issues	HHS SP -1 HP 1 26-10 26-11d 26-14, 26-15
2. Increase the number of integrated HIV service programs (O, E)	FY 06: TBR Cohort 2 ended. See narrative for discussion of data collection for Cohort 3 FY 05: TBR 9/04 FY 04: See narrative for discussion FY 03: See narrative for discussion FY 02: 55 services FY 01: Increase service by 30% FY 00: Establish baseline	FY 06: Cohort 2 ended. See narrative for discussion of data collection for Cohort 3. FY 05: TBR 9/06 FY 04: TBR 9/04 FY 03: TBR 5/04. See narrative for discussion FY 02: TBR 5/04. See narrative for discussion FY 01: Cohort 1- (a) youth: 100% increase (b) women: 100% increase (c) women and their children: 100% increase FY 00: Cohort 1-Baseline.: (a) youth: 1 (b) women: 0 (c) women and their children: 0
Total Funding:	2005: $44,988 2004: $39,654 2003: $39,799

Full Cost Table

10. Substance Abuse Prevention and HIV Prevention in Minority Communities Incorporates:	2003	2004	2005
10.1 (20%)	$8.9	$9.0	$9.0
10.2 (80%)	$36.0	$36.0	$36.07
Total Full Cost Funding ($'s in Millions)	$44.94	$44.99	$45.09

Program Description and Context

The goal of this program is to increase the capacity of communities serving the target populations to deliver evidence-based substance abuse prevention and HIV prevention services. Prior to this initiative, few programs integrated prevention services in the fields of substance abuse and HIV. Substance abuse prevention and HIV prevention healthcare services need to be delivered in a comprehensive system to address the dual epidemics of substance abuse and HIV. Outcomes are anticipated to include decreasing the number of substance abuse-related HIV infections while decreasing the consequences of substance abuse. Increased service capacity will help address the health emergency within the communities targeted by the National Minority AIDS Initiative.

This multi-disciplinary approach disseminates integrated prevention models to meet the needs of racial/ethnic communities. The most critical challenge is the promotion of education of public health providers in substance abuse and HIV/AIDS to increase integrated prevention intervention strategies to address multiple risks, reducing known risk factors that cross domains.

Performance Analysis

Measure 1: Increase perception of risk for substance use/abuse for youth receiving services which integrate substance abuse prevention and HIV prevention. Operationalized as the youth receiving services which integrate substance abuse prevention and HIV prevention.

SAMHSA is currently re-evaluating data collection for the HIV. FY 03 baseline data are now expected to be available in May 2004. Future targets will be set beginning with FY 2005.

Measure 2: Increase the number of service programs that integrate substance abuse prevention and HIV prevention services

SAMHSA is currently re-evaluating data collection for the HIV program. FY 03 data are now expected to be available in May 2004. Future targets will be set beginning with FY 2005.

Prevention Framework Priority Area
11. Synar Amendment Implementation Activities (Section 1926)

Performance Goals (Accountability)	Targets	Actual Performance	Reference
1. Increase number of States* whose retail sales violations is at or below 20% (O)	FY 06: 52 States FY 05: 52 States FY 04: 50 States FY 03: 50 States FY 02: 35 States FY 01: 26 States (Was 36 States) FY 00: 26 States	FY 06: TBR 7/06 FY 05: TBR 7/05 FY 04: TBR 7/04 FY 03: 46 States FY 02: 42 States FY 01: 30 States FY 00: 25 States FY 99: 21 States FY 98: 12 States FY 97 Baseline: 4 States
Total Funding:	See SAPTBG program for budget information.

Full Cost Table*

11. Synar Amendment Implementation Activities (Sec. 1926) Incorporates:	2003	2004	2005
11.1 (100%)
11.2
Total Full Cost Funding ($'s in Millions)

*Full Costs are assigned to the SAPTBG through which this program is funded. See table on page 40.

Program Description and Context

The goal of this program is to reduce the availability of tobacco products to youth under the age of 18. The program monitors State compliance with the requirement of the Synar legislation and its implementing regulation to enact and enforce laws to restrict the sale and distribution of tobacco products to minors. CSAP provides assistance to the States to enhance their ability to comply with Synar regulations. All States have established data collection and enforcement procedures to comply with Synar regulations, and many States are receiving technical assistance to improve their established procedures. CSAP also supports the States in reducing retail sales of tobacco to youth by providing guidance on policy and in assisting States with the identification of tobacco retail outlet lists. In addition, CSAP also provides guidance to improve collaboration between State and local authorities responsible for Synar compliance.

Performance Analysis

Measure 1: Increase number of States whose retail sales violations is at or below 20%

In FY 03, the target was not met; only 46 States/Territories achieved a sales violation rate of 20 percent or less. However, five additional States with violation rates slightly above the 20 percent target were found in compliance with the law by SAMHSA because their reported rates were within the required 95 percent confidence level of +/- 3 percentage points. Thus, a total of 51 States/territories were found in compliance with the Synar requirements. Further, 41 States reported sales violation rates of 15 percent or under, showing that those States achieved significantly better results than those required by law.

States that did not achieve the Synar goal of 20 percent or below reported that they experienced problems in implementing Synar due in part to budget reductions, which resulted in limited resources for program implementation and reductions in staff support. To ensure that these States meet the overall Synar goal, CSAP will continue to provide them with technical assistance services in the areas of enforcement, strategic resource allocation, program coordination and collaboration, and technology implementation, including individual State consultations with Synar Project Officers. In addition, CSAP is planning a multi-state technical assistance meeting early in Spring 2004 to assist these States with strategies to ensure program success and sustainability.

States continue to be required to achieve a 20% target rate beyond FY 2003. States that fail to achieve a 20 percent retailer violation rate with a sample margin of error of +/- 3 percentages points may receive a penalty of a 40% reduction in their total Block Grant funds.

Prevention Priority Area
12. 20% Prevention Set-aside, Substance Abuse Prevention and Treatment (SAPT) Block Grant

Performance Goals (Capacity)	Targets	Actual Performance	Refer-ence
1. Increase satisfaction with technical assistance (O)	FY 06: Maintain at 90% FY 05: Maintain at 90% FY 04: Maintain at 90% FY 03: Maintain at 90% FY 02: 90%satisfied; 80% response rate; 50% "outstanding" FY 01: 90% satisfied; 80% response rate; 40% "outstanding" FY 00: 90%; 60% response rate	FY 06: TBR 11/06 FY 05: TBR 11/05 FY 04: TBR 11/04 FY 03: 94% satisfied FY 02: 90% satisfied; 50% response rate FY 01: revised satisfaction survey under development FY 00: 90%; 60% response FY 99: 94%; 100% response FY 97 Baseline:90% satisfactory; 60% response; 25% outstanding	HHS SP -1
2. Increase services provided within cost bands (developmental) (E)	FY 06: TBR 10/05 FY 05: Establish baseline	FY 06: TBR 12/06 FY 05: TBR 10/05
3. Youth who have not used illicit substances in the past year (O) (Developmental)	FY 06: TBR 10/05 FY 05: Establish baseline	FY 06: TBR 12/06 FY 05: TBR 10/05
4. Perception of harm of drug use among program participants (O) (Developmental)	FY 06: TBR 10/05 FY 05: Establish baseline	FY 06: TBR 12/06 FY 05: TBR 10/05
5. Changes in non-use and in use among program participants in the past 30 days (Developmental)	FY 06: TBR 10/05 FY 05: Establish baseline	FY 06: TBR 12/06 FY 05: TBR 10/05
Total Funding:	See SAPTBG program for budget information.

Full Cost Table

12. 20% Prevention Set-aside, Substance Abuse Prevention and Treatment (SAPT) Block Grant Incorporates:	2003	2004	2005
12.1 (100%)	$353.0	$358.2	$368.8
12.2
12.3
12.4
Total Allocated Full Cost ($'s in Millions)	353.0	358.2	368.8

Program Description and Context

As required by legislation, 20 percent of Block Grant funds allocated to States must be spent on substance abuse primary prevention services. CSAP administers the primary prevention components of the SAPT Block Grant Prevention service funding varies significantly from State to State. Some States rely solely on the set-aside to fund their entire prevention system; others use the funds to target gaps and enhance existing program efforts. CSAP requires under regulation that the States use their Block Grant funds to support a range of prevention services and activities in six key areas to ensure that each State offers a comprehensive system for preventing substance abuse. The six areas are information dissemination, community-based process, environmental strategies, alternative activities, education, and problem identification and referral. SAPT Block Grant funds are the foundation of most States' prevention systems, driving their prevention planning processes and setting standards for their overall prevention systems.

Development of performance measures continues to be an area of highest priority for CSAP.
Performance information is used throughout the Center. Accomplishments have placed the agency in a strategic position to implement key provisions of Public Law 106-310, the Children's Health Act of 2000. This law requires CSAP to develop a plan for creating flexibility and accountability for States based on a common set of performance measures.

Performance Analysis

SAMHSA is working toward transforming the Block Grant into Performance Partnership Grants (PPGs). The PPGs will require greater accountability in exchange for State flexibility to design, implement, and evaluate community-based substance abuse prevention programs.
The PPGs include the development of performance measures to support planning in the Block Grant. At present, SAMHSA is finalizing a report on Performance Partnership Grants that was required by the Children's Health Act, and that identifies core measures.

Measure 1: Increase satisfaction with technical assistance

Performance was 94%, exceeding the target.

Measure 2: Services Provided within Cost-bands (Efficiency Measure under Development)

CSAP is developing an efficiency measure, and is considering developing cost bands for different types of prevention services. Baseline data are expected 10/05.

Measure 3: Percent of youth who have not used illicit substances (substances other than alcohol or tobacco) in the past year

This will be a key long-term outcome measure for the Performance Partnership Grant program, as required by PART. The data source will be 12^th graders as measured by Monitoring the Future. Program-level data may also be reported. Baseline data are expected 10/05.

Measure 4: Perception of harm of drug use among program participants

This will be an annual measure for the Performance Partnership Grant program as required by PART. Baseline data are expected 10/05.

Measure 5: Changes in non-use and in use among program participants in the past 30 days (Developmental)

Prevention programs often include those who have not yet used substances, as well as those who have begun using. Thus, the programs aim not only to reduce use, but also to prevent or delay use among those who have not yet started. This measure will reflect the percentage of participants whose use of substances either declined or stayed the same from the start of the program through 6-month follow-up.

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