Center for Substance Abuse Treatment
Substance Abuse Prevention and Treatment Block Grant

(Dollars in thousands)

Authorizing Legislation - Section 1921 of the Public Health Services Act

2005 Authorization Expired

Purpose and Method of Operation

The Substance Abuse Prevention and Treatment (SAPT) Block Grant Program distributes funds to 60 eligible States, Territories, the District of Columbia and the Red Lake Indian Tribe of Minnesota through a formula, based upon specified economic and demographic factors. Applications for FY 2005 grants are due October 1, 2004. Applications must include an annual plan that contains detailed provisions for complying with each funding agreement specified in the legislation, and describes how the applicant intends to expend the grant. The current law includes numerous specific provisions and funding set-asides, including a 20% prevention set-aside; an HIV/AIDS early intervention set-aside; requirements and potential reduction of the Block Grant allotment with respect to sale of tobacco products to those under the age of 18; a maintenance of effort requirement; and provisions that limit fluctuations in allotments as the total appropriation changes from year to year.

The program's overall goal is to support and expand substance abuse prevention and treatment services, while providing maximum flexibility to the States. States and territories may expend Block Grant funds only for the purpose of planning, carrying out, and evaluating activities related to these services. The legislation provides a 5% set-aside for data collection, technical assistance, and evaluation which is retained by SAMHSA for these purposes.

In 2001, the SAPT Block Grant accounted for approximately 40% of public funds expended by States for prevention and treatment. Sixteen States reported that greater than 50% of their total funding for substance abuse prevention and treatment programs came from the Federal block grant. Eight States reported block grant funding at greater than 60% of the total spent, while seven States reported over 70%. Over 10,500 community-based organizations receive SAPT Block Grant funding from the States. Since FY 2002, increases to the SAPT Block Grant have been included in the President's Drug Treatment Initiative. In FY 2001, an estimated 1.7 million persons were served.

Funds Distributed through Formula
Of the amounts appropriated for the Block Grant program, 95% are distributed to States through a formula prescribed by the authorizing legislation. Factors used to calculate the allotments include total personal income; State population data by age groups (total population data for Territories); total taxable resources; and a cost of services index factor.

Substance Abuse Prevention
For information on the 20% Prevention Set-aside, please refer to the separate Substance Abuse Prevention section of this budget document.

Substance Abuse Treatment
CSAT is responsible for administering the treatment funding aspects of the SAPT Block Grant program. States and Territories annually submit a report and plan to the Federal government describing how they expended Block Grant funds and how they intend to obligate Block Grant funds being made available in the current fiscal year. Targeted technical assistance is available to the States and territories through CSAT's State Systems Development Program (SSDP) and State Systems Technical Assistance Project (SSTAP).

Identifying appropriate and feasible performance measures for the Block Grant program (and for the forthcoming PPG program) and working with States to develop data systems that can support such measurement efforts have been key areas of focus over the past five years. Current measures related to funds distributed to the States include the number of persons served and the number of States voluntarily reporting performance measures in their SAPT Block Grant application. These measures will be retained for the PPG program.

A series of pilot studies funded by CSAT was successful in collecting outcome data, but sustained data collection has not occurred at the State level. Client outcome data for the SAPT Block Grant no longer are included in SAMHSA's GPRA report because the data submitted voluntarily were not based upon consistent methodologies and definitions.

Transition to Performance Partnerships
The Children's Health Act of 2000 required the development and submission to Congress of a report on plans for transforming SAMHSA's two block grants into Performance Partnerships. The draft Report to Congress, which is in final review, includes:

· The flexibility that would be given to the States under the plan;
· The common set of performance measures that would be used for accountability;
· The definitions of the data elements to be used under the plan;
· The obstacles to implementation of the plan and the manner in which such obstacles would be resolved;
· The resources needed to implement the performance partnerships under the plan; and
· An implementation strategy, complete with recommendations for any necessary legislation.

Essential to the transition to PPGs is support for State data infrastructure to implement needed data collection and performance measures. Data infrastructure support for treatment measures will be funded at $8.6 million in FY 2005.

5% Set-aside for Data Collection, Technical Assistance, and Evaluation
The 5% Set-aside provides funding to support State Data Systems, National Data Collection, Technical Assistance and Program Evaluation. A detailed listing of those activities and funding levels is provided in the Set-aside chapter. SAMHSA is allocating a total of $28.457 million for CSAT activities, including an increase of $3.1 million associated with the overall increase in funding for the SAPT Block Grant.

PART Review

The SAPT Block Grant was reviewed by OMB in the FY 2005 PART review. The review assessed strengths and identified a number of areas needing improvement. Although the overall rating was "Ineffective", the main area identified as requiring improvement related to performance measures. Certain key measures were finalized later in FY 2003 as part of the PPG process. States are heavily dependent upon the SAPTBG funding for substance abuse services that are urgently needed.

The PART review was helpful to SAMHSA in identifying the need for specific management actions. For example, in response to a PART finding, the program is expediting the posting of disaggregated State specific descriptive data on the Internet so that the data are fully accessible and transparent to the public. Also, the assessment found that SAMHSA faces continuing challenges in collecting performance data. SAMHSA's proposed Performance Partnerships will address this problem over time by implementing new measures, and improving data collection, analysis, and utilization. The assessment developed new performance measures that will be used for making future budget decisions. SAMHSA has made significant progress with the States in determining performance measures for the SAPT Block Grant program and States will begin reporting data on the measures developed to date in FY 2005. In addition, SAMHSA has initiated funding for a national evaluation of the Block Grant in response to an OMB finding.

Funding for the Substance Abuse Prevention and Treatment Block Grant program during the past five years has been as follows:

Funding FTE

2000..... $1,600,000,000..... 40
2001..... 1,665,000,000....... 40
2002..... 1,725,000,000....... 40
2003...... a/ 1,753,932,000.. 40
2004...... b/ 1,779,146,000.. 40

a/ Includes $62.2 million from the PHS evaluation funds.
b/ Includes $79.2 million from the PHS evaluation funds.

Rationale for the Budget Request

The FY 2005 budget proposes an increase of $53 million for this program. $79.2 million in PHS Evaluation funds continue to be provided as part of the total funding in FY 2005. The requested increase would result in an increase of about 5,000 admissions. The FY 2005 budget proposal will result in no States losing any funds as compared to their FY 2004 allotment. A detailed listing of those activities and funding levels is provided in the Set-aside chapter.

Substance Abuse and Mental Health Services Administration
Substance Abuse Prevention and Treatment Block Grant

Rating: Ineffective
Program Type: Block/Formula
Program Summary:

The Substance Abuse Prevention and Treatment Block Grant provides funding to states by formula to plan, carry out, and evaluate activities to prevent and treat substance abuse.

The assessment found:

• The Block Grant is the only federal program that provides funds to every state to support statewide substance abuse treatment and prevention services.
  

• The formula for distributing funds does not correspond with the prevalence of substance abuse. While states target funds to appropriate populations and the maintenance of effort requirement guards against supplantation, the likelihood of receiving federal support through the Block Grant for treatment varies by state.
  

• Existing annual measures provide information on outputs (i.e. number of states expressing satisfaction with the agency's technical assistance). These measures do not demonstrate progress toward achieving long-term outcome goals.
  

• While states currently report voluntarily on a number of outcome measures, states will be required to report on outcome and other performance data in exchange for additional flexibility under the performance partnerships.
  

• The program has not been evaluated at the national level.
  

• The program does not provide a budget presentation that clearly ties the impact of funding decisions on expected performance. The agency is developing new outcome measures that will enable the agency to better understand the impact of changes in funding and make budget decisions based on program performance.
  

In response to these findings, the Administration:

1. Proposes increased funding to continue the President's commitment to provide an additional $1.6 billion for substance abuse treatment over five years.

2. Will continue to develop new outcome measures for substance abuse prevention focused on age of initiation, total drug use, and/or other indicators of prevention effectiveness.

3. Will establish baselines and set targets for treatment and prevention performance measures.

4. Will continue to work with states to facilitate the transition from the Block Grant to performance partnerships to provide states additional flexibility in exchange for program performance.

Program Funding Level (in millions of dollars)

See Also:

PART Corrective Action Plan