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Director's Report
September 4 & 5, 2003
DIVISION OF STATE AND COMMUNITY SYSTEMS DEVELOPMENT
State Planning and Systems Development Branch
Mental Health Block Grant Program
Program Evaluation: In July 2003, the Office of Management and Budget (OMB) completed an evaluation of the CHS Mental Health Block Grant Program. The evaluation took 4 months and required detailed responses from Program staff to a series of 25 questions in OMB's Program Assessment Rating Tool (PART). OMB approved three goals and four long-term performance measures submitted by Program staff that are consistent with the purpose of the Block Grant Program. The goals and measures focus on capacity, effectiveness, and efficiency in the administration of the Block Grant Program and are expected to increase the accountability of all stakeholders.
Performance Partnership Grants (PPG) Initiative: As part of SAMHSA's comprehensive strategic planning effort to address accountability, capacity, and effectiveness, the Mental Health Block Grant Program is making the transition toward a PPG. The PPG reflects the SAMHSA model by moving toward greater accountability and reinforcing the flexibility of States already present in the Block Grant Program to design, implement, and evaluate community-based responses to serious mental illness.
As part of the transition toward a PPG, targets were set for the measure on reducing the rate of readmission to State psychiatric hospitals to within 30 and 180 days of discharge, using the 2002 Uniform Data Reporting System. Remaining measures will be addressed by the PPG initiative. All measures should be collected beginning in 2005. The data obtained will be used for long-range planning by State and Federal authorities to develop benchmarks on readmission rates that can be used as a quality indicator. All Mental Health Block Grant Program contracts for technical assistance and related oversight activities are committed to and support the long-term goals and objectives of the Program. In addition, the States have voluntarily entered into a process that should culminate in the changeover to a PPG, with increased emphasis on accountability and effectiveness.
Data Infrastructure Grants (DIGs): CHS has awarded grants to States and Territories to help support the costs of modifying their information systems to enable State reporting of new data tables under the Uniform Data Reporting System. The DIGs will continue to allow States to update their systems and to report the new data to CHS. In turn, CHS will use the data to better aggregate State data and develop a national picture of the State mental health systems. The data also will allow planning councils, consumers, and others in the States to more closely examine their planning activities for using the Mental Health Block Grant Program funds.
Monitoring: Since the last National Advisory Council meeting in June 2003, Block Grant Program staff conducted monitoring visits to New York, Oregon, Montana, and Virginia.
Minority Fellowship Program
The Minority Fellowship Program, jointly funded by all three of SAMHSA's Centers (CHS, CSAT, and CSAP), currently supports 89 Fellows through five professional association grantees. The program's purpose is twofold: (1) to facilitate the entry of ethnic minority students into mental health careers, and (2) to increase the number of psychologists, psychiatric nurses, psychiatrists, and social workers trained to teach, administer, and provide direct mental health and substance abuse services to ethnic minority groups. The program reflects SAMHSA's commitment to services that are professional, competent, and effective in meeting the critical mental health and substance abuse prevention and treatment needs of the Nation's diverse populations.
The first SAMHSA Minority Fellowship Program National Conference will be held December 12-13, 2003, in Washington, D.C. All current Fellows and a large number of former Fellows are expected to attend.
Aging Initiatives
Policy Academy on Aging: Over the past several months, the SAMHSA Workgroup on Aging has been planning a Policy Academy on Aging, a collaborative initiative with the Administration on Aging and other Federal partners. Modeled after the Policy Academy on the Homeless, its purpose is to ensure that older adults receive seamless services in mental health, substance abuse, primary care, and social services by emphasizing home- and community-based services and by coordinating programs and policies at the State level. It is designed to help States develop action plans for older adults' home- and community-based services. The Policy Academy will be facilitated by the National Governors Association and the National Council of State Legislatures. It will be open to State competition, and approximately 10 States will be funded in fiscal year (FY) 2004. FY 2003 funding will provide States with an orientation and preparation for the future competition, and States will receive ongoing technical assistance to help them develop applications and State plans.
Older Adult Consumer Alliance: The Older Adult Consumer Mental Health Alliance is helping the State Planning and Systems Development Branch to identify the priorities of older consumers and to further explore the implications of Mental Health Block Grant Program activities related to older mental health consumers. Specific Branch activities include: (1) conducting public education programs to help develop mental health and aging services and public support for these services; (2) expanding the Older Adult Consumer Mental Health Alliance as a resource to guide efforts for reducing elder suicide and the stigma related to older persons and mental illness and for developing and delivering accessible specialized services needed by older adults with mental illness; and (3) facilitating regional focus groups comprised of consumers, family members, caregivers, providers, and recognized experts to
develop National Standards of Care for providing specialized services to older adults with mental disorders.
Olmstead Training Institute
An Executive Order signed by President George W. Bush on June 18, 2001, directs key Federal agencies to work together and with States to ensure full compliance with the U.S. Supreme Court's ruling in the 1999 Olmstead case. The Olmstead Initiative that resulted from that case provides funding for State Mental Health Authorities to promote community-based care for individuals with mental illnesses. Since the Olmstead ruling, State Mental Health Authorities have participated in an annual training institute. On September 22-24, 2003, the 3rd Annual Training Institute for Mental Health Olmstead Coordinators will be held at the Georgetown University Conference Center in Washington, D.C. The theme is "Achieving the Promise Through Community Integration: Sustaining Progress and Strengthening Partnerships."
Protection and Advocacy Program
Interagency Protection and Advocacy Project: In FY 2002, SAMHSA entered into an interagency agreement with the Administration on Developmental Disabilities (ADD) to pool the protection and advocacy resources of three Federal agencies. The agreement supports a Training and Advocacy Center that was established under a 3-year contract with the National Association of Protection and Advocacy Services. SAMHSA, ADD, and the Department of Education's Rehabilitation Services Administration (RSA) jointly fund this project, and it is co-managed by SAMHSA and the Interagency Council on Developmental Disabilities. Individually, SAMHSA administers the Protection and Advocacy for Individuals with Mental Illness (PAIMI) program, ADD administers the Protection and Advocacy for Developmental Disabilities program, and RSA administers the Protection and Advocacy for Individual Rights program. This joint project maximizes the Federal training and technical assistance expertise of these Federal agencies and helps to avoid duplication of activities. Additional funds were provided in FY 2003 to continue this interagency project.
Protection and Advocacy Monitoring Tool: In FY 2002, the Mental Health Block Grant program convened a focus group to gather input for revising the Protection and Advocacy monitoring tool. The focus group was comprised of CHS/SAMHSA staff, 10 Protection and Advocacy Directors, and National Association of Protection and Advocacy Services representatives. Comments were solicited from all 59 Protection and Advocacy systems. The focus group addressed the comments received in several meetings and conference calls, and the final version of the tool is now complete. In FY 2003, the revised tool was used to monitor seven Protection and Advocacy systems: Louisiana, California, Florida, New Hampshire, American Indian Consortium, Nebraska, and Michigan.
On-site Technical Assistance
CHS continues to collaborate with national organizations to provide state-of-the-art policy analysis and technical assistance to stakeholders in State public mental health systems. The following organizations provided on-site technical assistance to State Mental Health Authorities: (1) the National Association of State Mental Health Directors, in conjunction with the Federation of Families for Children's Mental Health, the Judge David L. Bazelon Center for Mental Health Law, The National Alliance on Mental Illness, and the National Mental Health Association; (2) the National Association of Mental Health Planning and Advisory Councils; and (3) the National Technical Assistance Center and Advocates for Human Potential. These organizations identify experts on Federal and State mental health policies and practices to provide customized technical assistance to State Mental Health Authorities, planning councils, consumers, and families. Between June and September 2003, technical assistance was provided on a wide range of topics, including mental health parity, strategies for family involvement and statewide systems of care, diversity issues, seclusion and restraint in child/youth facilities, consumer advocacy, housing development, school violence prevention, community-based mental health services and supports, and fiscal management.
Survey and Analysis Branch
Decision Support 2000+: The CHS Survey and Analysis Branch is developing a clinical outcomes module for the Decision Support 2000+ System. When completed, the outcomes module will represent a small set of common clinical outcome measures for the entire mental health field that can be implemented over the Internet. An oversight group representing key stakeholders from the mental health field has begun holding meetings to discuss major content issues and approaches. Work on this project is expected to take 18 months.
Survey of Mental Health Self-help Groups and Organizations: The CHS Survey and Analysis Branch has completed the first national survey of mental health self-help groups and organizations run by and for consumers and family members, and the information collected is being analyzed. The survey included mutual support groups, self-help organizations, and consumer-operated services. It is estimated that there are more than 7,500 such groups/organizations in the United States. Preliminary analyses indicate that mutual support groups make up about 44 percent of the total; self-help organizations, about 41 percent; and consumer-operated businesses/services, about 15 percent.
Approximately 94 percent of these groups and organizations report that psychiatrists, therapists, hospitals, or mental health agencies refer people to their groups, demonstrating a connection between traditional mental health services and newer community supports. Services and supports provided by these groups and organizations that typically are not provided through traditional service systems include: social or recreational services (69 percent), warm lines (68 percent), referral and information lines (63 percent), outreach to members (40 percent), creative or performance arts activities (35 percent), hotlines (30 percent), spiritual or faith-based activities (12 percent), respite care (8 percent), and babysitting or child care (7 percent). In addition, approximately 49 percent provide case management services or help people get services to which they are entitled, 34 percent help people with housing difficulties, and 21 percent report helping people get jobs.
Forum on Common Performance Measures: On February 4-5, 2004, SAMHSA's three Centers (CHS, CSAT, and CSAP) will host the Second Forum on Common Performance Measures at the Carter Center in Atlanta, Georgia. Five work groups - adult mental health, child mental health, adult substance abuse, child substance abuse, and substance abuse prevention - will recommend common performance measures that span the mental health and substance abuse fields, based on administrative data and consumer survey data. The primary goal of the Forum is to begin implementing these common measures broadly across the mental health and substance abuse fields.
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