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IV. Strategies

SAMHSA’s program strategy to reach SAMHSA’s goals and HHS Goals 1 and 3 has two major elements:

• A matrix of priority areas and crosscutting principles, developed in consultation with the field. The matrix ensures that Federal resources are focused on current priorities toward improving the nation’s public health (Capacity and Effectiveness)

• Two year Action Plans in each matrix priority area, which are updated annually.

Key Factors Affecting Achievement of Goals

External factors beyond the Agency’s control could significantly affect the achievement of performance targets, positively or negatively:

• Changes in the number of people who receive prevention or treatment coverage through private insurance, e.g., through the loss or acquisition of jobs; through changes in the type of coverage provided by employers or health plans. (Capacity)

• Effect of the economy on the ability of State and local communities to maintain expenditures for prevention and treatment services, and to maintain availability and access to ancillary services, e.g., vocational services, education and employment, access to child care, available and affordable housing. (Capacity, Effectiveness)

• Stigma and discrimination attached to substance use and mental health disorders, which often make it difficult to acknowledge the problem and/or seek treatment. (Capacity)

• Changes in drug use patterns, including the availability of new or cheaper drugs, and in the effectiveness of supply reduction efforts. (Capacity, Effectiveness)

• World, National and local events, including terrorism, threats of terrorist attacks, war or a natural disaster. (Capacity, Effectiveness)

• Availability of substance abuse and mental health prevention and treatment services for criminal and juvenile justice-involved populations. (Capacity, Effectiveness)

• Action of the Congress, other Federal agencies, States, local governments, or other non-Federal entities, including availability of funding. (Capacity, Effectiveness)

• Changes in available human resources at Federal, State, and local levels. (Accountability, Capacity, Effectiveness)

Setting Priorities: The Matrix

To bring greater focus to the work of the Agency, SAMHSA initiated a dialogue with representatives of the substance abuse and mental health fields to help shape priorities for the immediate and longer-term future. The guidance and insight of the members of SAMHSA’s National Advisory Councils, constituents, staff, and other stakeholders were utilized to create a matrix that visually depicts SAMHSA’s priority programs and cross-cutting principles.

The matrix is an evolving tool. While it highlights SAMHSA priorities and reflects both HHS Departmental priorities and a public health approach to services, it does not preclude activities targeting other critical or emerging issues.

The matrix guides current program, policy, and resource allocation for the Agency. A senior SAMHSA official leads each matrix priority area. By focusing resources on fewer activities, SAMHSA can better leverage funds for maximum impact.

Matrix Area Action Plans

Each matrix area lead (with the help of a cross-agency workgroup) developed an action plan that covered FY 2004 and FY 2005. Action plans include a purpose statement; performance goals; policy and program parameters/ drivers; and action steps. Action steps must support SAMHSA’s strategic goals and objectives, and be consistent with the priorities of the Department of Health and Human Services (HHS) and, for substance abuse activities, the Office of National Drug Control Policy (ONDCP). The plans are updated each year. Summaries may be found at Appendix B and on the SAMHSA web site.

Program and Budget Planning

Matrix area leads participate directly in the Agency’s budget planning process, ensuring that matrix priorities drive budget proposals. Each major proposal or program is associated with the Accountability goal, the Capacity goal and/or the Effectiveness goal.

Four Key Initiatives (“Redwoods”)

The President’s Drug Treatment Initiative to increase treatment capacity, which began in FY 2002, resulted in a major new treatment program in FY 2004, the Access to Recovery (ATR) program. This program will increase substance abuse treatment capacity, consumer choice, and access to a comprehensive continuum of treatment options.

The Strategic Prevention Framework, which SAMHSA developed and began to implement in FY 2003, aims to: increase substance abuse prevention programming throughout the United States; to support the implementation of effective prevention programs in communities; and to promote the use of performance measures and evaluation tools by substance abuse prevention providers. The concept is now being expanded to include mental health promotion issues. SAMHSA now has a range of programs in place that can, assuming adequate support, accomplish movement toward these objectives. A new Strategic Prevention Framework State Incentive Grants program was implemented in FY 2004.

Mental Health System Transformation is SAMHSA’s response to the President’s Executive Order creating the New Freedom Commission on Mental Health, which issued its final report in July 2003. Report recommendations include reorientation of the system to the hope of recovery; prompt transfer of state-of-the-art treatments from research to community settings; and improved access to community based treatment and supports that are consumer and family driven and tailored to community needs. SAMHSA is implementing an action plan to respond to this matrix priority. A new Mental Health State Transformation State Incentive Grant program is being implemented in FY 2005.

The Co-occurring Initiative is SAMHSA’s response to the needs of individuals with both a mental disorder and a substance abuse disorder. Only a small percentage of these individuals receive treatment that addresses both disorders. In 1998, SAMHSA and the States entered into a collaboration to address problems associated with co-occurring disorders, culminating in the Report to Congress on the Prevention and Treatment of Co-occurring Substance Abuse Disorders and Mental Disorders. In FY 2003, SAMHSA initiated a Co-occurring State Incentive Grants program to enable States to develop and enhance their service system infrastructure to increase access to appropriate services and to reduce impairment for individuals affected by co-occurring disorders.

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