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Center for Mental Health Services
Year-end Report
October 1, 1998 to October 31, 1999

The Center for Mental Health Services (CMHS) has been extremely active over the past year, primarily because of a series of high-profile activities at the national level that are focusing attention on mental health issues and reinforcing CMHS efforts to meet the needs of people with mental illnesses and their families. For example:

• The Safe Schools/Healthy Students Initiative, funded by SAMHSA/CMHS and the Departments of Education and Justice, awarded more than $100 million in grants to 54 communities to promote healthy childhood development, foster resilience, and prevent youth violence. President Clinton announced the grant awards in his weekly radio address on September 11, 1999. The funds will be used by local school districts to help communities design and implement comprehensive educational, mental health, social service, law enforcement, and juvenile justice services for youth.
• By embracing the development of the U.S. Surgeon General's Report on Mental Health, scheduled for release in December 1999, U.S. Surgeon General David Satcher made mental health one of his top initiatives. The Surgeon General's report, much like earlier reports on smoking, nutrition, and other health topics, will present a comprehensive review of the state of knowledge on mental health, including an assessment of "leading edge" scientific research and treatment. The HHS Secretary designated CMHS as the lead agency in developing the first report from the Surgeon General to focus exclusively on mental health. The high-profile nature of the report presents an extraordinary opportunity for CMHS to focus public attention on: promoting mental health; reducing the stigma associated with mental illness; encouraging early recognition and intervention for mental health problems; and promoting effective, appropriate service delivery systems that enhance mental health treatment for millions of Americans in their own communities.
• Mrs. Gore and Surgeon General Satcher, leading an effort on behalf of HHS, are developing a national media campaign to reduce the stigma of mental illness. They have enlisted the help of the Ad Council, MTV, the American Psychological Association, and a number of private-sector entities. The campaign is expected to be launched in conjunction with the release of the Surgeon General's Report on Mental Health in December.
• Surgeon General Satcher issued a Call to Action to Prevent Suicide, a program that outlines steps that can be taken by individuals, communities, organizations, and policy makers.
• A White House Conference on Mental Health, chaired by Mrs. Tipper Gore, National Advisor to the President on Mental Health, was held June 7, 1999. CMHS helped to set the agenda and develop the messages of this conference. Conference messages were: mental health services work; education, employment, and housing are both sought after and possible goals for people with mental illness; and the stigma that has long prevented people from seeking mental health treatment must end. The conference brought together consumers, providers, advocacy groups, lawmakers, business and community leaders, and authorities on mental health research and pharmacology, service delivery, and insurance coverage.
• CMHS and SAMHSA's Center for Substance Abuse Treatment (CSAT) are continuing a national dialogue on co-occurring mental disorders and substance abuse, conducted jointly with the National Association of State Alcohol and Drug Abuse Directors and the National Association of State Mental Health Program Directors. The effort focuses on the financial aspects of providing care for persons with co-occurring disorders.

CMHS continues to increase its focus on enhancing the delivery of culturally competent mental health services. A few examples of recent efforts follow:

• In July 1999, CMHS convened an Asian American and Pacific Islander National Mental Health Summit, which brought together providers, researchers, consumers, family members, and administrators.
• The Community Action Grant Program Hispanic Priority Initiative, begun in 1998, is directed at mental health and substance abuse prevention and treatment needs of Hispanic communities. Six new grants were awarded to Hispanic grantees in 1999.
• The Circles of Care Program, just completing its first year, is bringing more support services into Native American communities so children with serious emotional disorders can remain with their families while undergoing treatment.
• The CMHS Minority Fellowship Program, now in its 24th year, is aimed at increasing the number of minorities who enter mental health professions. In the last 5 years, CMHS has funded $3.3 million in fellowships.
• CMHS staff was part of the 3-person health and mental health team that provided services for the more than 4,000 Kosovar Albanian refugees at Fort Dix, New Jersey.

These initiatives are described in greater detail throughout the report.

LEGISLATIVE UPDATE

S. 976 would establish new Federal grant programs to develop community systems to prevent and treat violence and its consequences in younger populations, establish a new Federal grant program to "wrap around" mental health and substance abuse services for youth offenders, and reauthorize the existing SAMHSA discretionary and block grant programs. Discretionary grant programs are to give priority in future funding to the interface between mental health, substance abuse, and primary care.

PROGRAM ACTIVITIES AND INITIATIVES

• Remarks on school violence and suicide at the 126th Annual Meeting of the American Public Health Association in Washington, D.C., November 1998.
• Keynote address on the CMHS school violence prevention program to the first annual Public Policy Institute of the National Association of School Psychologists in Washington, D.C., February 1999.
• Presentation at the Crisis Counseling Assistance and Training Workshop for State Disaster Mental Health Coordinators in Emmitsburg, Maryland, June 1999.
• Keynote address at the Asian American and Pacific Islander National Mental Health Summit in Bethesda, Maryland, July 1999.
• Remarks at the National Association of State Mental Health Program Directors Summer Commissioners' Meeting in Pittsburgh, Pennsylvania, July 1999.

The Office of the Director continues discussions with its mental health counterparts in Russia, as part of a larger departmental and government-wide initiative, and also continues to educate visitors from other countries about how the U.S. delivers mental health services. In February 1997, the Russian Minister of Health and the U.S. HHS Secretary identified disaster and emergency mental health issues as a new area of potential collaboration under the Gore-Primakov Commission Health Committee.

CMHS Deputy Director Thomas H. Bornemann and Brian Flynn and Robert DeMartino of the Division of Program Development, Special Populations, and Projects received Public Health Commissioner Corps Honor Awards for contributions to increased international understanding of disasters and related emergency mental health.

Findings from the HIV/AIDS Mental Health Services Demonstration Program about the mental health needs of people living with or affected by HIV/AIDS continue to be disseminated. This knowledge is expected to shed new light on approaches to providing integrated care to persons with HIV/AIDS. Policy makers, health care providers, and others who serve this population will have the opportunity to learn from the experiences of the 11 grantees and to replicate the most promising approaches in their own communities.

The Office of the Associate Director has distributed 5,000 copies of Mental Health Care for People Living With or Affected by HIV/AIDS: A Practical Guide. Five thousand additional copies are being printed.

CMHS continues to concentrate on a three-pronged HIV/AIDS strategy of education, prevention, and service delivery systems. All three of the major HIV/AIDS programs - Education, Prevention/Intervention, and Treatment Adherence, Health Outcomes, and Associated Costs - have held steering committee meetings during the year.

CMHS is working with the SAMHSA Associate Administrator for AIDS on a variety of HIV/AIDS issues. Dr. Karina K. Uldall, a new member of the CMHS Advisory Council, was appointed to the SAMHSA Council subcommittee on AIDS.

The Office of the Associate Director for Medical Affairs, in collaboration with the American Psychiatric Association (APA), convened a meeting of psychiatrists, psychiatry residents, and medical students to examine cultural competence in psychiatry education. Meeting participants focused on strengths and barriers and identified individuals and organizations to assist with addressing barriers.

CMHS staff is planning a workshop for the American Association of Directors of Psychiatry Residency Training (AADPRT) to be held in Spring 2000. In addition, the Associate Director's office continues to work with both APA and AADPRT on a variety of other projects, including development of quality indicators for service systems, steps to prepare for a well-trained workforce to operate under emerging health care systems, and the Practice Research Network. The APA established the CMHS-funded Practice Research Network in 1993 to address a need to expand the clinical science base of psychiatry beyond traditional research findings. It is a nationwide network of psychiatrists who collaborate on collecting data and conducting research studies on a variety of clinical and health services delivery issues in both public and private treatment settings.

The CMHS Office of Managed Care, in cooperation with CSAT's Office of Managed Care, has initiated a contract to conduct an evaluation on the impact of the Vermont Parity Act, enacted in 1997. Vermont's statute includes substance abuse and does not restrict parity to specific diseases, making this State's law more comprehensive than any other in the nation. Vermont's Department of Banking, Insurance, Securities, and Health Care Administration requested assistance from CMHS/SAMHSA in evaluating the Act.

The CMHS Office of Managed Care, in cooperation with the CMHS Division of State and Community Systems Development, has begun a contract to assess the effectiveness of pre-admission screening and annual reviews for individuals with mental illness who are applicants to or residents of Medicaid-certified nursing facilities. The contract will also evaluate the adequacy of mental health treatment in Medicaid participating nursing facilities. The project will address questions related to the connection between diagnosis and treatment of mental illness and nursing facility admission, discharge, and transfer. Procedures for the screening, identification, and treatment of persons with serious mental illness and the extent of "specialized" mental health services provided by States will also be examined.

The CMHS Office of Managed Care recently initiated a contract to provide logistics support for six state and regional training sessions related to health care reform. Each training session will be planned and conducted by the National Mental Health Association and will involve approximately 50 participants. Potential sites for the sessions include Oregon, Vermont, Iowa, Connecticut, Mississippi, and Rhode Island. In addition to logistics support, CMHS will contribute to the educational component of the sessions in these areas: basic principles of managed care, systems of care for children, Medicaid nuts and bolts, consumer rights, long-term care, quality assurance and monitoring, and State policy and delivery system trends. Training curricula will be tailored specifically to delivery systems in individual States and will include presentations from key State health care leaders, legislators, and Governors' offices, as well as staff of local and national advocacy organizations.

Office of Managed Care Public Health Advisor Shelagh Smith was presented with an Honor Award from the National Capital Area Chapter of the Society for Public Health Education (SOPHE). The approximately 4,000 national members of SOPHE work in the public health education professions, including hospital and State government, university research, national public health policy, and communications. The award is given to an individual or organization that contributes significantly to the field of health education or health promotion and is instrumental in the advancement of the profession.

In April 1999, the Information Center unveiled a new web site design to make the site more user-friendly and visually appealing. The new design is easy to navigate and provides quick access to State resource guides for mental health services, mental health fact sheets and publications to download or order, links to mental health resources on the Internet, grant funding opportunities, and a searchable calendar of mental health conferences and events.

The Information Center entered its new web site design in the spring competition of the World Wide Web Health Awards and received a Bronze Medal in the category of "Best Site Structure and Navigation." The most visited sections on the site include Mental Health Information, Links, Publications, Databases, and Mental Health: The Cornerstone of Health.

The Information Center continues to expand its outreach to those seeking information on mental health and mental illness. More than 1,000 people contact the Information Center daily via phone, fax, e-mail, and the web site. More than half a million people have used the Information Center's web site as a source of mental health services information and resources since it became operational in March 1996. On its single most active day, the web site was contacted 20,169 times. During one single month, the Information Center logged 172 inquiries from Australia, 48 from Japan, and 26 from Saudi Arabia. Most users (nearly 70 percent) access the Information Center web site during evening hours. On average, more than 50 new links, many of them reciprocal, are added each month.

The Information Center currently offers 240 publications on diverse aspects of mental health and mental illness. Nearly 600,000 publications have been distributed since the Information Center's inception, and nearly 300,000 publications were distributed during this past year alone.

The Information Center was recognized in the American Medical Association's June 1999 Cultural Competence Compendium "for its contributions to enhancing the cultural competence of physicians." CMHS received written acknowledgement in August 1999 from the American Medical Association's Vice President of Medical Education.

The 1999 American Academy of Family Physicians Scientific Assembly, the premier convention for family physicians, focused on Mental Health 2000 at its annual meeting in Orlando, September 15-19, 1999. The Information Center was chosen to be an exhibitor based on its ability to offer a variety of printed materials that illustrate the importance of mental health in every stage of life. The Information Center was one of three exhibits chosen to receive an Outstanding Exhibit Award for presentation and relevance of materials to the target audience and to the featured conference topic of mental health. More than 7,000 physicians, representing all types of practices across the nation, attended the meeting.

Also in November 1998, Consumer Affairs staff chaired a Mental Health Section Town Hall Meeting on Public Health Citizen Involvement for approximately 100 participants at the American Public Health Association (APHA) Annual Meeting. Staff also organized a meeting for more than 40 consumers and family members on increasing consumer involvement in APHA.

Consumer Affairs staff convened a dialogue between consumers and psychiatric-mental health nurses this July in Washington, D.C. Designed to explore methods of partnership building, the meeting was the third in a series of dialogues supported by CMHS. One notable recommendation from the meeting was to schedule a national multi-disciplinary dialogue that includes consumer advocates, psychiatric nurses, psychologists, psychiatrists, social workers, and occupational therapists.

CMHS is sponsoring the development of a training video for residents of psychiatric programs to improve communication and therapeutic partnerships with consumers. The video was produced based on a recommendation from the first CMHS-supported dialogue between consumers and psychiatrists in 1997. As a result of the second CMHS-supported dialogue, the 1999 national meeting of the American Psychological Association included a mini-convention focusing on collaboration between psychologists and consumers.

Consumer Affairs staff is working on a number of activities to reduce the stigma of mental illness. Efforts include oversight of a SAMHSA-wide Anti-stigma Work Group; production and distribution of a video entitled "Stigma…in Our Work, in Our Lives, " created by the Anti-Stigma Project of On Our Own of Maryland, Inc., a statewide consumer advocacy group; development of bilingual radio PSAs for distribution to Spanish-language stations; and development of a guidebook to address stigma in the media. In addition, Consumer Affairs staff developed an anti-stigma poster. The poster's message, developed based on input from consumer focus groups, is "Know me as a person, not by my mental illness" and is part of an anti-stigma tool kit that includes brochures. Efforts are currently underway to create a Spanish-language anti-stigma poster.

In August 1999, Consumer Affairs staff made a presentation about CMHS anti-stigma activities to the Surgeon General's staff in preparation for a National Anti-Stigma Campaign being developed by the White House. On the day following the presentation, Senior Policy Analyst Paolo del Vecchio and CMHS Director Bernard S. Arons participated in a White House Conference concerning the National Anti-Stigma Campaign.

Consumer Affairs staff leads the SAMHSA-wide Consumer Bill of Rights and Responsibilities Work Group. Publications are being developed to explain the Consumer Bill of Rights and Responsibilities and give exemplary practices of implementation. On June 25, 1999, Consumer Affairs staff made a presentation on the Consumer Bill of Rights to the 22nd Annual National Association of Protection and Advocacy Systems' Advocacy Training/Technical Assistance Center Conference in Washington, D.C.

A briefing was held for SAMHSA staff on the Olmstead vs. L.C. Supreme Court decision and the three employment-related cases regarding the definition of "disability" within the Americans with Disabilities Act. An HHS work group is implementing activities to promote and expand home and community-based services under Olmstead.

CMHS is currently working with a planning group of representatives from national consumer organizations to assist in the development of a Consumer Subcommittee of the CMHS National Advisory Council. The group convened a meeting in July 1999 to develop criteria for subcommittee membership and to determine processes for identifying and selecting potential members.

Consumer Affairs staff is planning two regional mental health consumer meetings in San Francisco and New York, as part of a continuing effort to promote and elicit consumer involvement and expertise. Staff continues to facilitate networking begun last year with the People of Color Consumer Network, including support of a multi-cultural institute at the Alternatives Conference in October 1999. In addition, CMHS awarded scholarships to 14 mental health consumers from the U.S. to attend the World Federation for Mental Health 1999 Congress in Santiago, Chile, in September. These delegates will submit a report about consumers and self-help activities in other parts of the world and the potential impact of this information on their local communities.

Consumer Affairs staff continues to manages a number of ongoing projects, including: a guidebook for consumers on self-advocacy skills and recovery; a pamphlet on the use of grievance procedures in managed care environments; a how-to guide on organizing dialogue meetings to develop partnerships among mental health stakeholders; a monograph that examines the self-identified issues, needs, and experiences of lesbian, gay, bisexual, and transgender consumers/survivors of mental illness; and a manual on the role of the arts in mental health and recovery.

In January 1999, the Office of External Liaison (OEL) staff arranged for a CMHS exhibit at "4 Your Health and Fitness Expo," a yearly event sponsored by WRC-TV, the NBC affiliate in Washington, DC. WRC-TV interviewed Dr. Arons about depression screening as part of the station's news programming about the Expo. The CMHS exhibit, which included a depression-screening booth, was one of only four exhibits chosen for news stories. The Expo featured 150 exhibits and attracted more than 70,000 visitors to the Washington, DC Convention Center.

On March 11, 1999, the nationally syndicated television newsmagazine, "Fox Files," aired an interview with Dr. Arons in which he discussed current Federal efforts to study the use of restraint and seclusion.

Also in early March, the Wall Street Journal interviewed Dr. Arons about the increased attention that primary care physicians are paying to the mental health needs of their patients as a result of the rise of managed care.

OEL faxed a letter and fact sheet about the CMHS Safe Schools/Healthy Students Initiative to news outlets across the nation following the tragic school shootings in Littleton, Colorado. National Public Radio's "All Things Considered" and The Washington Post responded. The Post invited Child, Adolescent and Family Branch Chief Gary DeCarolis to interact with its readers on "Health Talk," an on-line session hosted by Health Editor Abigail Trafford. Ms. Trafford highlighted Mr. DeCarolis' comments and insights in a column entitled, "Angry Youths Need Early Aid," which ran in the April 27 special Health section of The Post.

Dr. Arons was the sole guest on local NBC affiliate WRC-TV's half-hour news show, "Viewpoint," which aired May 16, 1999. Dr. Arons discussed the progress made in the mental health arena over the past 50 years, noting that May 1999 was the 50th anniversary of Mental Health Month. His remarks covered progress made in medical advances for mental illness, as well as successful efforts to reduce the stigma associated with mental illness.

On May 27, 1999, Dr. Arons was a featured panelist on WAMU 88.5 FM-radio, where he discussed the reintegration into society of people with mental illness. Hosted by Kojo Nnamdi, the live show, "Public Interest," was aired through National Public Radio to listeners across the nation. Callers phoned in questions that sparked discussion about a host of issues related to stigma and the obstacles that people with mental illness face.

On June 17, 1999, Dr. Arons was interviewed by Redbook magazine about youth and depression.

On June 30, 1999, National Public Radio's "The Infinite Mind" interviewed Knowledge Development and Systems Change Division Director Michael J. English about youth violence prevention.

On July 7, 1999, The New Yorker magazine interviewed Dr. Arons for an article about CMHS' work with Mrs. Gore in her role as National Advisor to the President on Mental Health on the President's Task Force on Health Care Reform.

On July 8, 1999, Business Week magazine interviewed Child, Adolescent and Family Branch Chief Gary DeCarolis about resources for parents of children with mental illness.

On July 9, 1999, the Philadelphia Inquirer interviewed Associate Director for Medical Affairs Dr. Melvyn R. Haas about the danger of extreme weather temperatures for people taking psychotrophic medications.

Also on July 9, 1999, Time magazine interviewed Office of Policy, Planning, and Administration Senior Policy Analyst Paolo del Vecchio and Senior Social Science Analyst Crystal Blyler about the employment of people with mental illness. The article was published at the end of August.

On July 30, 1999, OEL Public Affairs Specialist Robert Grace provided background information About Us and its 800 number for publication in Family Circle magazine as part of a list of numbers for "What to do if Your Teen Needs Help."

In addition to these media outreach efforts, CMHS responded to requests for mental health statistics from several news organizations. MSNBC and NBC Nightly News requested information about the number of people in mental health facilities and their diagnoses. NBC Nightly News also asked about the number of available psychiatric beds in the U.S. The Washington Times requested numbers on persons with mental illness in the U.S.

In July, OEL Director Curtis R. Austin attended the Unity '99 Conference in Seattle, Washington, a meeting of more than 6,000 minority journalists from across the nation, in an effort to build working relationships with media representatives and increase coverage of mental health issues and SAMHSA/CMHS programs. The conference, held every four years, is a joint effort of the Native American Journalists Association, Asian American Journalists Association, National Association of Hispanic Journalists, and the National Association of Black Journalists. Mr. Austin met individually with broadcast media representatives from Good Morning America, ABC News, and local ABC affiliate WJLA at the conference. Mr. Austin also had one-on-one meetings with print media representatives from the Los Angeles Times, Atlanta Journal and Constitution, Knight Ridder, Reuters, and the Associated Press, as well as several other general assignment and health reporters. In addition, he participated in a conference workshop on youth and substance abuse moderated by ABC Weekend Anchor Carole Simpson. Shortly after the conference, the Executive Vice President of ABC News notified Mr. Austin that information about the CMHS Safe Schools/Healthy Students Initiative and the forthcoming U.S. Surgeon General's Report on Mental Health in the United States had been forwarded for future programming consideration to the producers of "World News Tonight" and "Nightline."

On June 3, 1999, CMHS staff sponsored a caucus for consumer participants at the National Mental Health Statistics Conference. Participants raised a host of issues, including the need to: educate mental health providers about stigma; sponsor additional consumer forums for older adults; adopt consistent and concrete standards for planning the annual "Alternatives" conference; develop better data, guidelines, and training for protection and advocacy (P&A) programs; and expand authority and improve training for State Planning Councils. Participants also noted that the CMHS State Network and Community Action grants, which provide direct funding, have been very effective.

On June 11, 1999, CMHS staff held a caucus at the National Mental Health Association Clifford Beers Conference for approximately 50 advocates, consumers, family members, and others. Caucus participants identified several needs, including: focusing more attention on HIV/AIDS and co-occurring issues and examining integrating mental health and substance abuse funding streams; ensuring that grant applicants have adequate time to submit quality proposals; educating practicing psychiatrists about consumer experiences; addressing mental health implications of chronic pain; and continuing advocacy efforts on behalf of older adult consumers. With regard to stigma, participants suggested that efforts to educate students about stigma should begin early, while they are still in elementary school.

DIVISION OF KNOWLEDGE DEVELOPMENT AND SYSTEMS CHANGE

The branch received its second Hammer Award from Vice President Gore's office for its work on the Circles of Care Program. The Hammer Award is presented to individuals and organizations that are leading the way in improving public perception of the effectiveness and responsiveness of government. The Circles of Care Program, which is just completing its first year, supports the development of projects to improve services to children with serious emotional disturbances in Native American communities. The program is designed to bring more support services into the communities so those children with serious emotional disorders can remain with their families. It is a collaborative effort of 9 Indian tribes and 13 Federal agencies, including the Departments of Interior, Justice, and HHS.

CMHS recently funded a second 5-year contract to continue its social marketing campaign, Caring for Every Child's Mental Health: Communities Together. The campaign provides technical assistance to grant sites upon request, helping them to make the best use of campaign tools and strategies, and responds to information requests from both grant sites and the general public through its toll-free number. Under the new contract, the scope of the campaign has been broadened to include outreach to communities beyond the grant sites. Campaign materials, including brochures, posters, fact sheets, articles, and public service announcements, were distributed throughout 1999. New products, developed under the leadership of the Federation of Families for Children's Mental Health, include a Spanish-language poster and brochure about children's mental health and a guide for families written in English and Spanish. The Caring for Every Child's Mental Health campaign was featured at the White House Conference on Mental Health, held June 7, 1999.

In January 1999, the Child, Adolescent and Family Branch, the Annie E. Casey Foundation, and the National Technical Assistance Center for Children's Mental Health at the Georgetown University Child Development Center began planning the Urban Initiative. The initiative is based on the premise that developing and sustaining comprehensive local systems of care in large urban centers requires unique skills and strategies that may not apply in other environments. Under the initiative, a series of activities will focus on gathering and sharing knowledge learned from the CMHS urban grants and from the four sites funded by the Casey Foundation through its Urban Mental Health Initiative.

An Urban Initiative Advisory Committee of 20 members with diverse perspectives was convened in July 1999. Members were selected primarily from the CMHS and Casey Urban Mental Health grant sites. An Advisory Committee Meeting was held July 12 and 13, 1999, in Baltimore, Maryland. The Georgetown University Child Development Center provided technical expertise. The Advisory Committee recommended potential activities and products for the Urban Initiative.

Four technical assistance meetings were held in 1999 for communities and Indian tribes interested in applying for the upcoming round of Comprehensive Community Health Services for Children and Their Families Program grants. At these meetings, held in Washington, DC, and Denver, Colorado, staff from the Child, Adolescent and Family Branch walked participants through the grant application process. A key focus of the meetings was to help attendees grasp the concept of community-based systems of care and the importance of applying this concept to project designs. Overviews of the national evaluation and social marketing campaign were provided, including a discussion of grantees' roles in these efforts. The meetings also included sessions addressing family involvement, cultural competence, financing issues, and interagency partnerships. Applicant teams and individuals received individualized guidance on issues of their own choosing. A total of 89 individuals representing 46 communities and Indian tribes attended the technical assistance meetings. A meeting transcript was available upon request to those unable to attend.

CMHS has published a new seven-volume series for families, communities, and caregivers to use in building effective systems of care, Promising Practices: Systems of Care for Children with Serious Emotional Disturbances and Their Families in the United States of America. The series was developed by grantees funded by the CMHS Comprehensive Community Mental Health Services Program for Children and Their Families. Through this series, CMHS is making available knowledge gained from the first 5 years of the grant program on how to support and serve children with serious emotional disturbances and their families.

The information in the Promising Practices series was primarily gathered from the experiences of the original 31 program grantees. Research was conducted through site visits, focus groups, a national program evaluation, and professional and parent interviews. Data collection methodologies were specifically designed to be family-focused, community-based, culturally relevant, and inclusive. Volumes in the series describe promising practices in training, service delivery, collaboration, school coordination, managed care, cultural competence, and roles for families in systems of care. Over 2,700 full sets of the Promising Practices monographs have been distributed, along with more than 1,000 of each individual volume. A number of additional titles on other relevant topics are currently being developed and will be published in FY 2000.

Child, Adolescent and Family Branch Chief Gary DeCarolis authored a chapter on state-level supports for community-based services in a newly published book, Where Children Live: Solutions for Serving Young Children and Their Families, edited by Richard N. Roberts and Phyllis R. Magrab.

Child, Adolescent and Family Branch staff also co-authored an article, "Answering a Traditional Call with a Community Response," for the Summer 1999 issue of Reaching Today's Youth. The story illustrates the benefits of community-based systems of care in helping families to strengthen their capacity to care for their children. The article focuses on a single family in an urban community and highlights the many resources that can be made available through collaborative community efforts.

Fifteen programs in 10 States were awarded a total of $8.5 million in grants to develop effective integrated systems for treatment and care of women who are victims of violence and have co-occurring mental health and substance abuse disorders. The two-phase Women and Violence Study is expected to generate valuable knowledge on the confluence of violence and co-occurring mental health and substance abuse disorders affecting women and their children. Research has shown that existing health care systems are inadequately designed and are not prepared to address the issues relating to co-occurring disorders in women, including family violence and the effects on children.

The Criminal Justice Diversion Multi-site Study is in its second year, and data collection is proceeding with over 500 subjects enrolled. There are nine sites across the country, plus a technical assistance center and a coordinating center. The program held its sixth steering committee meeting in April 1999, in Tucson, Arizona. At the meeting, plans for process evaluation and final plans for a cost benefit analysis were approved, preliminary descriptive findings were presented from the cases enrolled, and a consumer subcommittee was formed. Sites in New York, Tennessee, and Hawaii have made particularly significant strides in effecting systems of change. The program has resulted in new collaboration between the New York District Attorney's office and the New York Mental Health Court clinics. A Mayoral report from the Commissioner of Health was issued, and legislation is being written by the New York State Senate to fund an integrated MIS system. In Memphis, the Crisis Intervention Team Program has been so successful that more than 25 cities have expressed interest in replicating it.

On August 26, 1999, Community Support Programs Branch staff attended the first meeting of CMHS Consumer/Consumer-Supporter Statewide Networking Grant projects in Portland, Oregon. The meeting was arranged by the National Mental Health Consumer's Self-help Clearinghouse and held in conjunction with the National Summit of Mental Health Consumers and Survivors. Representatives from 19 of the 30 funded projects attended the afternoon meeting, along with representatives from four CMHS Technical Assistance Centers and both National Institute on Disability and Rehabilitation Research (NIDRR) Centers to which CMHS contributes funding. Each grantee reported on activities of the past year, highlighted accomplishments and difficulties encountered, and shared their plans for the coming year. Technical Assistance and Research and Training Center representatives provided a brief overview of the resources provided by their centers and responded to needs raised by grantees. Grantees have requested another meeting for next year to share information and report on progress.

A report based on data provided by States, published in August, summarizes local implementation of Projects for Assistance in Transition from Homelessness (PATH) during 1995 and 1996. Reports on 1997 and 1998 PATH-funded activities will be published shortly.

Two papers that describe findings from the Access to Community Care and Effective Services and Support (ACCESS) Program have been accepted for publication. One paper presents lessons from the ACCESS Program on creating successful systems integration strategies, and the other examines the effectiveness of long-term street outreach for homeless persons with serious mental illness. Approaching its final year of operation, this 5-year demonstration program has shown that service system integration is related to improved access to housing services and better housing outcomes for homeless people with mental illness.

In May 1999, the ACCESS Program received the HHS Secretary's Award for Distinguished Service. The award was presented to program staff for "excellence in and dedication to both scientific rigor and relevant health services policy in the development, conduct, and outcome products of the ACCESS study of homelessness and serious mental illness."

A new branch program, "Cooperative Agreements for CMHS/CSAT Collaborative Program on Homeless Families: Women with Psychiatric, Substance Use, or Co-occurring Disorders and Their Dependent Children," better known as the "Homeless Families Program," received special attention when it was announced by Vice President Gore during the June 7th White House Conference on Mental Health. This 5-year initiative, to be carried out in two phases, will document and evaluate short-term, multi-faceted interventions targeted to homeless women with psychiatric and/or substance use disorders who are caring for dependent children.

On June 17 and 18, 1999, the Homeless Programs Branch sponsored a 2-day workshop on the Benefit/Cost of Providing Homeless Services. The workshop was designed to review current findings, identify the policy decisions that lend themselves to benefit-cost analysis, examine ways to facilitate the use of benefit-cost analysis by consumers and administrators, and outline an agenda for future investigation.

Homeless Programs Branch staff have provided technical assistance to States in the areas of employment interventions, co-occurring disorders, and outcome measures. A telephone conference on cultural competency in providing homeless services was sponsored for State PATH contacts and local PATH-funded providers. Homeless Programs Branch staff also organized a panel presentation on PATH at the annual meeting of the National Alliance to End Homelessness, July 16, 1999.

On September 16 and 17, 1999, the Homeless Programs Branch sponsored a workshop on Employment and Vocational Rehabilitation for Homeless Persons with Serious Mental Illnesses. Six discussion papers were prepared for the meeting, which was attended by consumers, service providers, and State mental health and vocational rehabilitation commissioners and researchers.

In late September 1999, CMHS, along with CSAT, conducted a visit to the grant site for the Anchorage Comorbidity Services Project. This project is a Congressionally mandated initiative for the development, implementation, and evaluation of a comprehensive, seamless system of care for persons with co-occurring substance abuse and mental disorders. CMHS will oversee the project's updated evaluation plan and proposed implementation. Development and implementation of the initiative will include both resource and program development and the organizational and management support needed to transition from the current approach to one that is truly seamless and provides clients with appropriate services throughout their involvement with the treatment systems.

Homeless Programs Branch Chief Dr. Walter Leginski began a 12-month detail in the Office of Program Systems of the Assistant Secretary for Planning and Evaluation at HHS, on August 2, 1999. Dr. Frances Randolph is currently the Acting Branch Chief. DIVISION OF PROGRAM DEVELOPMENT, SPECIAL POPULATIONS, AND PROJECTS

Division of Program Development, Special Populations, and Projects Director Brian Flynn accompanied Vice President and Mrs. Gore to Littleton, Colorado, to attend memorial services and meet with the families of victims of the Columbine school shootings.

A CMHS crosscutting initiative, Prevention of Suicide Across the Lifespan, is under development. Two workshops on suicide prevention are being planned in the coming year. The first of these will explore present knowledge and future strategy on the outcome of suicidal behaviors and will report on what is currently known about the services received by and health outcomes of persons with suicidal behaviors. Workshop participants will identify gaps in knowledge, make recommendations for future areas of investigation, and provide practical guidance on developing and implementing surveys to study persons with suicidal behaviors. Another meeting will bring together a group of suicide prevention experts, advocates, and practitioners to outline the scope of work for the continued development of a National Strategy for the Prevention of Suicide and to create a timeline for its progress and completion. The meeting is being sponsored by CMHS, in conjunction with the U.S. Surgeon General and other HHS agencies. The scope of work to be developed will include a conceptual framework, measurable objectives, resources, policy gaps, models, and ways to monitor progress.

CMHS will also sponsor a workshop related to terrorism in the coming year. The workshop will explore knowledge and national strategy in preparing for and responding to the psychosocial consequences of terrorist acts involving weapons of mass destruction and will establish an expert consensus on the behavioral and mental health issues involved. Workshop participants will identify knowledge gaps; make recommendations for future areas of investigation; identify the most pressing training, educational, and technical assistance needs of States and localities; and develop a timetable for meeting these needs.

Following the Summit, CMHS agreed to prepare a formal written response to recommendations from Summit participants and to maintain regular contact with the Asian American and Pacific Islander communities to monitor implementation of the recommendations. CMHS plans to implement several projects in FY 2000 that will have a direct impact on Asian American and Pacific Islander populations.

The CMHS Clinical Training Payback Data Unit continues to track and monitor more than 3,000 clinical training stipend recipients to ensure compliance with the service payback obligation incurred as a result of receiving support for training.

From June 21 to 25, 1999, the Emergency Services and Disaster Relief Branch and the FEMA co-sponsored the Crisis Counseling Assistance and Training Workshop at the National Emergency Training Center in Emmitsburg, Maryland. The workshop presented various aspects of disaster mental health concepts and case studies, and featured lectures, small group discussions/activities, and panel presentations on disaster mental health topics designed to prepare State departments of mental health to respond to Presidentially declared disasters. Representatives from State departments of mental health received technical guidance on the organization of disaster responses, the Crisis Counseling Assistance and Training grant application process, and the development of State emergency operations plans to prepare for disasters.

The Vice President's National Partnership for Reinventing Government Hammer Award was presented to the FEMA/CMHS Crisis Counseling Assistance and Training Program in August 1999. The program, now in its 25th year, received the award for exemplary interagency partnership and services to disaster victims.

CMHS recently signed a new interagency agreement with the U.S. Department of Justice, Office for Victims of Crime (OVC) for a 2-year project to advise the OVC and other Federal, State, and local entities on appropriate mental health activities for victims of Federal crimes, particularly terrorist events and mass violence. The project will be administered by the Emergency Services and Disaster Relief Branch and will build on the experiences of the FEMA/CMHS Crisis Counseling Program.

FEMA/CMHS Crisis Counseling grants were awarded for 16 disasters in FY 1998. These included projects responding to Hurricane George and to major tornadoes in Oklahoma and other Midwest States.

The first-ever Advanced Training for State Disaster Mental Health Coordinators was held from September 27 to 30, 1999. A newly developed curriculum addressed some of the more complicated issues challenging service delivery.

A new publication, "Psychosocial Issues of Older Adults," was developed in cooperation with the National Council on Aging. Designed to improve crisis-counseling services to older adults during disasters, the publication was released and distributed during August and September.

A new training video, "Hope and Remembrance," was also developed. The video focuses on how the anniversary of a disaster affects survivors and shows how mental health services can help survivors cope at this time.

The School Action Grant Program, funded by CMHS and CSAT, reviewed grant applications in July 1999. The program funded 40 applicants that selected evidence-based practices to prevent youth violence, foster healthy child development, meet community needs, build consensus around practices, and implement best practices.

CMHS has contracted with the Georgetown University Child Development Center to develop a monograph to assist administrators of early childhood programs in hiring mental health consultants. Staff working in early childhood settings may encounter children who have behavioral problems, who are at risk for mental disorders, and whose parents face stress. The monograph will be a practical document with guiding principles and concrete examples of how a mental health consultant can help a particular staff member or program.

In June 1999, the Special Programs Development Branch convened a working group meeting of key resilience experts to begin the process of creating a solid, scientific basis for future investigation of fostering resilience.

The Branch is supporting a project on "Using Indigenous Models of Resilience in Violence Prevention Programs for Native American Children and Youth." CMHS is also supporting the development of a summary of a book entitled, "Fostering Resilient Children, Youth, Families, and Communities: Strengths-based Research and Policy," which will be distributed to policy makers and the general public.

CMHS assisted with the development of a public radio program on resilience. Special Programs Development Branch staff were invited to be on Dr. Dan Gottlieb's "Voices in the Family" program on WHYY Radio, a community public radio station serving southeastern Pennsylvania, Delaware, and South Jersey. Christopher Reeve and Diane Rehm were also part of this program, which aired on September 13, 1999.

The Special Programs Development Branch is supporting the development of a Directory of Domestic Violence Programs and Services for Refugee and Immigrant Women. The directory will include shelters, counseling programs, university research projects, and other resources.

Branch staff were members of a team that provided medical services to Kosovar Albanian refugees in "Operation Provide Refuge" at Fort Dix, New Jersey. Staff helped admit and resettle refugees and coordinated services provided to them. Branch staff was invited to go with an International Delegation to Kosovo on September 7, 1999.

Refugee Mental Health Program staff of the Special Programs Development Branch delivered a presentation on the resettlement of Muslim refugees in America at the 36th Islamic Society of North America Annual Convention. The convention, held September 3 to 6, 1999, in Chicago, Illinois, provided a forum for bringing together Muslim leaders, scholars, professionals, business leaders, and families. Branch staff also addressed a session of the American Islamic Association of Mental Health Professionals.

DIVISION OF STATE AND COMMUNITY SYSTEMS DEVELOPMENT

The Branch continues to collaborate with the CMHS Survey and Analysis Branch on the State Performance Indicator Pilot Project. The project helps States to report on a number of performance indicators and measures for State mental health programs, with a focus on outcomes. It allows CMHS and the States to test and measure mental health services at the State and local levels to improve quality, accountability, and effectiveness of care. As such, the project is helping to build a bridge between the data and planning components of Federal and State mental health programs.

The Block Grant Program is exploring a number of new initiatives, including providing technical assistance to States based on need and special requests. Discussions are also underway to involve historically Black colleges and universities and higher educational institutions with large numbers of Hispanic students as resources for training mental health professionals who serve African-American and Hispanic populations.

The Survey and Analysis Branch held its National Conference on Mental Health Statistics, June 1 to 4, 1999, in Washington, DC. Approximately 450 representatives from State, community, academic, consumer, and family groups participated in the 48th National Conference. The theme, "New Developments for the Next Millennium: Measuring What Counts and Making It Count," introduced the Mental Health Information Prototype for the Next Millennium, which is based upon an integrated information system that includes population statistics, service quality and access, and outcomes and recovery data. The conference included special sessions on integrated delivery systems within mental health, between mental health and substance abuse, and between mental health and primary care. Highlights included sessions on: the emerging role of consumers as data reporters and collectors, Kosovo refugees, the future of information technology, the farm crisis, the U.S. Surgeon General's Mental Health Report, and the Branch's 16-State Performance Indicator Project to enhance the reporting capacity of State mental health data systems.

Survey and Analysis Branch Chief Dr. Ronald W. Manderscheid organized and chaired a panel on "Mental Health as a Public Health Issue," on July 2, 1999, at the 20th Annual Meeting of The National Alliance on Mental Illness (NAMI), in Chicago, Illinois. The panel, comprised of representatives from the private, substance abuse, consumer and family, and public health sectors, focused on ways of incorporating mental health into the public health arena and making it a community concern. NAMI is collaborating with the American Public Health Association to launch a new national organization, Public Health Advocates.

The Survey and Analysis Branch collaborated on the preparation of a collection of articles, "Psychosocial Rehabilitation in a Managed Care World," for two special issues (Winter/Spring) of the International Journal of Mental Health. Written for those who use or provide psychosocial rehabilitation, the articles explore the impact of managed care on rehabilitative services for individuals living with a mental disorder who need help in housing, employment, and independent living. Topics in the two special issues include: contemporary mental health systems, case management in behavioral health care, employment programs, psychosocial rehabilitation in managed care, new approaches to psychosocial rehabilitation, and the role of families.

As the world enters a new millennium, CMHS will remain dedicated to its mission of improving and increasing the quality and range of mental health treatment and support services for adults with serious mental illness and children with serious emotional disturbances. Through research and data collection, information dissemination, identification and implementation of promising practices, and partnerships with mental health stakeholders, CMHS will continue to offer hope to people with mental health needs and their families.

KEN01-0018
2/2000

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