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2005 Authorization Expired
Purpose and Method of Operation
Programs of Regional and National Significance include CSAT's entire
discretionary budget. These resources are CSAT's primary tool to focus Federal
funding on particular service improvements and priority needs. Proposed funding
reflects an increase of $98 million above the 2004 final Conference level.
Funding will support 655 grants and contracts, with 491 continuation
grants/contracts and 164 new/competing grants/contracts. Funds for all programs
will continue to support evaluation and technical assistance.
In SAMHSA, there are two major program categories within Programs of Regional
and National Significance. The first category promotes capacity expansion
through services programs, which provide funding to implement a service
improvement using a proven evidence based approach; and through infrastructure
programs, which identify and implement needed systems changes. Key success
indicators for most programs of this type are improved client outcomes, systems
changes, and numbers of clients served. The second category promotes
effectiveness through local best practice programs, which help communities and
providers to identify, adapt, implement, and evaluate best practices; and
service to science programs, which document innovative practices thought to
have potential for broad service improvement. In general, the outcomes of these
programs are measured by indicators such as the identification of a practice to
be implemented and pilot adoption; satisfaction with information or assistance
received; actual changes to practice that have occurred; and participant
outcome data. In FY 2003, CSAT's Targeted Capacity Expansion programs served
approximately 30,000 clients. Outcome data show positive results (see page GPRA
38). While many activities contribute to CSAT's accomplishments, several major
programs account for the majority of funding.
As mentioned previously, an increase of $100.6 million is proposed for the Access
to Recovery program for a total of $200 million in FY 2005. The SBIRT
program will be funded at $25.7 million in FY 2005, including a $2 million
increase for program evaluation. A description of these programs may be found
later in this section.
Approximately $34 million are expended for programs that address the problem of
homelessness among those with substance abuse disorders. As many as half of
homeless adults have histories of alcohol abuse or dependence, and one third
have histories of drug abuse. Many have a co-occurring mental illness.
Accordingly, SAMHSA funds States and communities to provide mental health and
substance abuse services specifically for homeless individuals.
Approximately $61 million are allocated for capacity expansion programs that
provide outreach and substance abuse treatment for African American,
Latino/Hispanic, and other racial and ethnic minority populations which have
been disproportionately affected by substance abuse and HIV/AIDS. These
services can reduce the spread of HIV/AIDS in these communities.
Approximately $26 million support programs that address the substance abuse
treatment needs of adults and adolescents who become involved in the criminal
justice system. Improved services can reduce the number of individuals entering
or returning to jail or prison for reasons related to substance use disorders.
The CSAT PRNS program was selected for OMB PART review in FY 2004. The program
was challenging to review because it is really a set of complex programs, many
of which are relatively new. The program was found to be "Adequate" overall,
but received a lower score on the "program results" section than on other
sections. A corrective action plan focusing on that section as well as
improving elements of other sections was developed and approved.
The corrective action plan focuses on the elements within each section of the
PART which received low scores. The corrective action plan includes a PRNS
management plan using GPRA data, with an emphasis on setting long term goals,
improving data collection and evaluation, and increasing program monitoring to
ensure that PRNS grantee targets are being met.
Over the past year, several changes have been implemented consistent with the
corrective action plan. Web based data systems have been implemented to improve
data collection, analysis, and reporting. To support new data systems and
implement cost band measures, technical assistance has been provided to
grantees. The milestone of evaluating the PRNS set of programs has been
addressed in part by initiating evaluations of the major new ATR and SBIRT
programs.
OMB recommended that incentive and disincentive procedures for grantees be
developed to improve efficiency and cost effectiveness. Guidelines have been
developed and implemented. Performance expectations on cost will be raised
incrementally to improve efficiency. New milestones have been identified in
this effort to improve program effectiveness and efficiency.
Funding for CSAT PRNS during the past five years has been as follows:
Funding FTE
2000....... $214,390,000 -
2001....... 255,985,000 -
2002....... 290,567,000 -
2003....... 317,278,000 -
2004....... 419,219,000 -
Rationale for the Budget Request
Treatment Capacity Priority Area
Capacity: Access to Recovery (Total funding: $200 million, of which $98 million
is from the PRNS increase.)
In FY 2004, $99.4 million will fund approximately 13 grants to States to support
the new Access to Recovery (ATR) program. As envisioned, ATR will be a voucher
program administered through the States. The initiative would allow individuals
seeking clinical treatment and recovery support services to exercise choice
among qualified community provider organizations, including those that are
faith-based. An initial assessment will be conducted for each individual to
determine the appropriate level of services for that individual, which would
include a range of possibilities including recovery support services, brief
interventions, and more intensive clinical treatment. In FY 2005, funding is
proposed to total $200 million, half of which will be from the proposed PRNS
increase. The increased funding is expected to support 13 additional grants.
The program's emphasis is on results - measured by outcomes in seven domains
including decreased or no substance use, no involvement with the criminal
justice system, attainment of employment or enrollment in school, family and
living conditions, social support, access/capacity, and retention in services.
The same domains will be used for the Performance Partnership (Block) Grants.
At the proposed funding level, approximately 100,000 people will receive
services through this program in FY 2005.
Capacity: Screening, Brief Intervention, Referral, and Treatment (Total
funding: $25.7 million, of which $2 million is from PHS Evaluation funds.)
In FY 2003, $22 million were awarded for 7 grants to States and one technical
assistance contract to increase treatment capacity and to improve treatment
systems by expanding the continuum of care available in communities.
Improvements are expected to result in increased access to clinically
appropriate treatment matched to the person's stage of illness and problem
severity. This investment will be continued in FY 2004.
In FY 2005, $2 million in PHS Evaluation funds are proposed to fund a contract
for a major evaluation of SBIRT which will build on CSAT's data collection and
reporting for Government Performance and Results Act purposes by addressing
issues in the implementation of funded projects and their fidelity to grantee
plans. The evaluation will document activities, accomplishments, and outcomes
at the State level, the sub-recipient community level, and the provider agency
level. Both a process and an outcome evaluation would be conducted. The process
evaluation would focus on the number of clients screened, the population
served, and the settings where services are performed. The outcome evaluation
would focus on discerning the outcomes for the four covered population groups
(screened only; screened and received brief intervention; screened and received
brief treatment; and screened and received full treatment.) The results will
allow SAMHSA to make any needed improvements in the program and to recommend
the appropriate level of future investments in the program.
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