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Statement by
Elaine Parry
Acting Deputy Director, Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration
on
SAMHSA's Role in Eliminating Racial and Ethnic Disparities in Health
before the
Congressional Black Caucus, the Congressional Hispanic Caucus, and the Congressional Asian Pacific American Caucus

April 12, 2002

Good morning. My name is Elaine Parry and I am the Acting Deputy Director for the Center for Substance Abuse Prevention within the Substance Abuse Mental Health Services Administration. I will be presenting testimony on behalf of our Administrator Mr. Charles Curie and the agency as a whole.

First, let me take this opportunity to thank the Congressional Black Caucus, the Congressional Hispanic Caucus and the Congressional Asian Pacific American Caucus for your unwavering leadership, in focusing our country's attention on the continuing and unacceptable health disparities that keep minority and economically disadvantaged populations from accessing and using effective preventive health and health treatment services so vitally needed to ensure the basic precursors to success and actualizing human potential.

We are particularly grateful for the very substantial support you have provided for SAMHSA's activities and particularly funding for the Minority HIV/AIDS Initiative.

We welcome this opportunity to highlight some of SAMHSA's efforts to eliminate racial and ethnic health disparities. As you know, SAMHSA is the lead federal agency charged with strengthening the capacity of the Nation's health care system to provide substance abuse prevention, addiction treatment and mental health services for all Americans. We mean ALL Americans. We know far too well that minorities experience greater disparities in access to care, and quality of care and suffer disproportionately from the burdens of disease and disabilities and the consequences of abuse.

Let me tell you what SAMHSA is doing to eliminate racial and ethnic disparities. These activities either help to ensure that every community and every person has access and uses effective, culturally and developmentally appropriate programs and services or assist States to build the capacity and infrastructure necessary to extend services to all communities and people.

Let me take a few minutes to provide concrete examples of how these three SAMHSA goals have been implemented to decrease existing health disparities.

SAMHSA has developed a National Registry of Effective Prevention Programs (NREPP). An expert consensus process in which all published and unpublished materials are reviewed and evaluated is used to identify model or promising programs -- that is, programs that have been well-implemented, well-evaluated and produced consistently positive patterns of results clearly demonstrating their effectiveness.

The Registry includes the provision of technical assistance and training for communities wishing to undertake adoption or adaptation of effective programs. This is key to ensuring that adopted programs maintain their effectiveness when implemented locally.

In a further effort to disseminate best practices, SAMHSA has a Memorandum of Understanding with the HHS Office of Minority Health to collaborate on getting science based model programs to ethnic populations.

SAMHSA, due to your efforts, has a Minority HIV/AIDS Initiative. This initiative seeks to improve the nations effectiveness in providing integrated substance abuse prevention/treatment services and HIV/AIDS prevention/treatment services as well as mental health services for persons living with HIV/AIDS in our minority communities.

In prevention, SAMHSA is in the process of funding its third cohort of service providers. Our initial effort in prevention under this initiative in F.Y.99 resulted in the funding of 48 grants targeting women and youth of color. This cohort was encouraged to do project level evaluation to determine effectiveness and participation in a cross-site evaluation was encouraged.

Our second effort in prevention in F.Y.01 was a three tiered initiative which introduced: a) planning grants to assist in the development of infrastructure and capacity in minority communities -- process evaluation only (40 grants); b) expansion grants to identify best practices with respect to achieving integrated service delivery -- process and outcome evaluation required (20grants); and c) youth serving grants -- project level evaluation (pre/post) -- 17 grants.

The third cohort which is to be funded this year(FY 02) will again feature planning grants and services grants with emphasis on youth. The last two cohorts will also participate in a cross-site evaluation to assist us in looking at trends that may be used to inform future program direction.

In mental health, SAMHSA's HIV/AIDS Mental Health Services Capacity Building in Minority Communities grantees are funded to expand service delivery to meet both unmet and emerging mental health treatment needs of people living with HIV/AIDS from racial/ethnic minority communities.

SAMHSA has a Targeted Capacity Expansion Treatment program focused on HIV among minority populations. This year SAMHSA has over $57 million funding 127 grants serving over 17,000 patients. These are grants to enhance and expand substance abuse treatment and HIV/AIDS services to racial/ethnic communities highly affected by the twin epidemics of substance abuse and HIV/AIDS.

In all of SAMHSA's Minority HIV/AIDS grants, funding is directed to activities designed to deliver services specifically targeting racial and ethnic minority populations impacted by HIV/AIDS.

SAMHSA's Community Disparities Program works specifically to reduce disparities by increasing access and delivery of culturally appropriate substance abuse prevention, treatment and mental health services to racial and ethnic minority populations. This is a collaborative effort within SAMHSA involving all three centers being the lead partner. Right now, this program includes five grants targeting: Latina women in the U.S. Mexico Border region; Native American female adolescents; Asian American women; Vietnamese survivors of "re-education" camps: and Latina female adolescents. All of these programs have been designed to provide culturally relevant, gender-specific, and age appropriate mental health and substance abuse services.

We are also working to increase the capacity of the field to conduct culturally sensitive and relevant research, training, instrumentation and use of minority researchers.

Block grants remain the primary mechanism in which SAMHSA builds State capacity to provide access to quality care. We are working on a shifting of the current program to a performance partnership based on increasing State flexibility in the use of funds and accountability based on performance. Data under this new program will be submitted that includes among other things racial and ethnic breakouts permitting SAMHSA to better understand how minority populations are being served in the States.

The Cultural Competency Network which SAMHSA supports obtains guidance on how to improve the cultural competency of our products, documents and services such as technical assistance. We seek guidance from the people we want to serve. So, we developed African American, Asian Pacific Islander, Hispanic/Latino and Native American Workgroups to get relevant feedback. CSAP also brings racial and ethnic groups together to provide feedback on our products and plans to expand that to examination of our services.

I could not leave here today without mentioning the report the Surgeon General released last year entitled, "Mental Health: Culture, Race and Ethnicity." The report emphasized that mental health is fundamental to overall health and productivity. It is the basis for successful participation in family, community and society. Once again the Surgeon General stated that it is all too easy to dismiss the value of mental health until problems appear. These problems are real and if left untreated, mental illnesses can result in disability and despair for families, schools, communities and the workplace. This toll is more that society can afford. Unfortunately, minorities have less access to and availability of mental health services; are less likely to receive needed mental health services; and receive a poorer quality of services when they do receive them. In many cases, it isn't the mental health problem that causes the disability but the lack of avail quality care which results in minorities becoming more disabled with mental illnesses that might otherwise be treated and the individual able to participate in life, the community and society.

As a direct result of the report, SAMHSA published an announcement as part of our Building Mentally Healthy Communities Initiative to provide funding for programs targeting reductions in racial/ethnic disparities in mental health or access to mental health services. Programs like that in Multnomah County, Oregon are focusing on reducing ethnic and racial disparities in the provision of mental health services for Latinos. The Asin Access Project in Connecticut is reducing the ethnic and racial disparities among Asian Americans in Hartford. Reaching Out to the Elderly in Public Housing is a program in New York City reducing ethnic and racial disparity among primarily African American Elderly individuals living in public Housing.

Let me conclude my comments by discussing what needs to done next.

• We will be increasing technical assistance and training to minority and faith-based organizations to help them gain the skills to compete for SAMHSA`s programs.

• We plan to build stronger partnerships and collaborative relationships with minority community based organizations.

• We must build stronger partnerships among Federal agencies to maximize our resources and expand our services to the community.

• We need to continue to close the treatment gap and make sure everyone who needs services gets quality, barrier free and culturally respectful services.

• We need to continue to work to ensure that every community has effective prevention programs in place. That we truly reach everyone and have policies, and programs in place that support young people in being alcohol, tobacco and drug free.

Thank you for the opportunity to share SAMHSA efforts to eliminate health disparities. I am available for questions.