SAMHSA FY Budget for 2005
Substance Abuse and Mental Health Services Administration
Significant Items for the House, Senate and Conference Appropriations Committee Reports - House Report No. 108-81

[Mental health services for school-aged youth]  Suicide continues to be the third leading cause of death for teens, but only one-third of youth with mental illness, one of the major risk factors for suicide, are identified and are in treatment. Evidence-based screening tools to detect at-risk youth are available. Some school districts have taken advantage of this and offer students a voluntary, school-based mental health check-up. Such screening should occur with parental and youth consent, and with a commitment to make treatment available for those found to be at-risk. The Committee urges SAMHSA to make these efforts more widely known and to collaborate with other Federal agencies, specifically the Department of Education and the Department of Justice, as well as public and private entities, to provide voluntary mental health check-ups to all school-aged youth. The Committee directs SAMHSA to report on steps being taken to promote this effort prior to the fiscal year 2005 appropriations hearings. 

Action taken or to be taken
The Committee requested a report on the steps being taken to promote this activity before the 2005 appropriations hearings. The information is provided below.

SAMHSA is currently supporting the development of school-based suicide prevention guidelines in response to a set of objectives given by the National Strategy for Suicide Prevention. These guidelines provide information on how to create comprehensive, suicide prevention programs. The guide also offers descriptions of over 30 exemplary, school-based suicide prevention programs, including several screening programs utilizing evidence-based screening tools. SAMHSA plans to work in collaboration with the Department of Education, the Department of Justice, CDC and other pertinent agencies to promote dissemination of these guidelines.

SAMHSA will meet with NIMH, CDC, and other Federal partners, to discuss the requirements, feasibility, advisability, and necessary next steps to promote widespread implementation of screening programs for teenagers.

The program components of the Safe Schools/Healthy Students (SS/HS) initiative include screening for mental illness, substance abuse, and other risk factors for danger to self or others. The SS/HS initiative is an interagency effort involving the Federal Departments of Education, Justice, and Health and Human Services. SAMSHA will collaborate with the Department of Education to develop and disseminate school-based suicide prevention guidelines that incorporate evidence- based youth screening programs.

SAMSHA will provide a report on the activities to promote availability of evidence-based mental health screening tools.

[Access to Recovery]    The Committee provides $100,000,000 for the "Access to Recovery" substance abuse treatment voucher initiative rather than $200,000,000 as requested. The Committee supports the Administration's commitment to increase substance abuse treatment capacity, consumer choice, and comprehensive treatment options. The Committee is concerned, however, that SAMHSA has not previously piloted the program on a smaller scale and recommends that the funding provided be used to establish the program in States that have the necessary infrastructure to administer this new and innovative program. To the extent that data are available, the Committee encourages SAMHSA to report to the Committee regularly on the status and continued design and enhancement of the program. (Page 102)

Action taken or to be taken
SAMHSA will encourage applicants to propose strategies for ensuring the use of assessment and placement criteria developed by national experts, and for holding all providers that receive funding under the voucher program to the same standards of care, licensure, and certification requirements as other programs that deliver similar services in their respective States. SAMHSA will report to the House and Senate Committees on Appropriation 30 days after Access to Recovery funds are distributed regarding the States that applied for and received grants, the amount awarded to each state and the services each State will provide with these funds.

[Performance measurement]    The Committee emphasizes the importance of the development and implementation of performance measures and expects that performance measurement will be an integral part of all substance abuse treatment programs. The Committee is pleased that SAMHSA is developing the new treatment voucher program with performance as an important component. It is the Committee's expectation that SAMHSA will begin integrating performance measurement into the Substance Abuse Prevention and Treatment Block Grant in fiscal year 2004 as States prepare to move to the Performance Partnership Grant program. As data become available on the development of performance guidelines and of the actual performance of these programs, the Committee strongly urges SAMHSA to provide the Congress periodic updates. SAMHSA should be prepared to testify on the performance of these programs at the fiscal year 2005 appropriations hearing. (Pages 101-102).

Action taken or to be taken
SAMHSA's PPG Report to Congress, as well as its Reauthorized proposal that contains the statutory changes needed to implement PPG's, are nearing final preparations for submission to the Department.

Both SAMHSA and the States have made considerable progress toward PPG implementation. With regard to the Mental Health Block Grant, CMHS has been working with the States to establish and implement the "Uniform Reporting System" (URS), which contains all the core PPG Measures proposed for mental health. Regarding the SAPT Block Grant, well over half the States have established performance measurement and reporting systems that will enable them to incorporate and report on the proposed PPG measures for substance abuse in their program management and reporting processes.

In addition, both the FY2005 mental health and substance abuse Block Grant applications are in the final stages of being revised, as follows:

Item
[Health disparities] - According to Healthy People 2010, the rapidly growing and diverse Asian American and Pacific Islander (AAPI) populations on the U.S. mainland, Hawaii, and Pacific Regions, are experiencing a number of critical health disparities. The increased incidence of substance use and abuse among AAPI youth and adults has gone unaddressed due to the lack of relevant data and research, culturally competent service programs, and the lack of awareness among constituent communities. The Committee urges SAMHSA to increase its work with the network of AAPI community-based organizations, constituents, and other community members to create greater awareness about substance abuse and to improve substance abuse services for the AAPI communities. (Page 102)

Action taken or to be taken
SAMHSA's FY 2004 Annual Plan for the Minority Initiatives is in response to the Department of Health and Human Services' Initiative on Eliminating Health Disparities for Racial and Ethnic Populations and regarding Executive Order 12876: Historically Black Colleges and Universities
(HBCUs); Executive Order 12900: Hispanic Agenda for Action/Hispanic Serving Institutions (HAA/HSIs); Executive Order 13125: Asian-Americans and Pacific Islanders (AAPIs); and Executive Order 13201: Tribal Colleges and Universities (TCUs).

Using SAMHSA's matrix of priority programs and principles, mission, and vision as a guide, four goals were developed for SAMHSA's FY 2004 Annual Plan for the Minority Initiatives. Listed under each goal is an example of a SAMHSA strategy to reach these goals.

1) Translating science to services by synthesizing information on evidence-based practices and accelerating the process whereby effective mental health and substance abuse treatments and interventions are identified and translated into widespread practice.

• Use the National Registry of Effective Programs (NREP) to identify and disseminate substance abuse prevention and treatment interventions that are specifically applicable to minority communities.

2) Increase access to, and use of, Federal resources and services by minority institutions and minority entities by strengthening the knowledge, skills, and abilities of these organizations and entities to be competitive for Federal resources.

• Provide assistance to minority institutions and minority entities in securing Federal and other external funds. This includes obtaining funding to support the Executive Development Leadership Institute (EDL) program that will target training and technical assistance to minority community based entities.

3) Increase access and eliminate barriers to services by standing on the principle that regardless of race, gender, ethnicity, or geographic location, all culturally diverse populations should have access to quality and available mental health and substance abuse services.

• Identify ethnic-specific prevention access to service and service delivery disparities and needed resources to develop culturally appropriate strategies to facilitate the elimination of existing disparities. This includes increasing the availability of non-English language informational materials, increasing the availability of professionals who are culturally competent to work with minority and/or limited English proficiency populations, and increasing the amount of anti-stigma information materials and approaches used by minority institutions and minority entities.

4) Institutionalize and develop SAMHSA's infrastructure by identifying and committing designated staff and fiscal resources to implement, monitor and evaluate objectives set forth in the White House Initiatives on Historically Black Colleges and Universities (HBCUs),

House Report No. 108-188

Hispanic Agenda for Action/Hispanic Serving Institutions (HAA/HSIs), Asian-Americans and Pacific Islanders (AAPIs), and Tribal Colleges and Universities (TCUs).

• Provide SAMHSA with a Geographic Information System (GIS) System that will enable SAMHSA Program Administrators to analyze the concentration of ethnic populations and identify SAMHSA activities targeted to these ethnic groups.

Item
[Treatment voucher program]   The Committee is very interested in the innovative treatment voucher initiative and understands that the State of Maine has been implementing a voucher program with their State funds for five years. As the voucher system is developed, the Committee urges SAMHSA to examine ways in which to promote this funding option and to encourage States to incorporate vouchers into their State plans. (Page 103)

Action taken or to be taken
SAMHSA will support a voucher program that is designed to give individuals the choice of treatment and/or recovery support options that best meets their needs.