Overview of SAMHSA's Performance Management Strategy: 2006 I am…

Overview of SAMHSA's Performance Management Strategy: 2006

I am pleased to make this second annual report to the Nation on the partnership among
the Substance Abuse and Mental Health Services Administration (SAMHSA) and the
States to implement the National Outcomes Measures (NOMs) for prevention and
treatment of substance use and/or mental disorders. The domains we have identified--
and are well along in implementing--embody meaningful, real life outcomes for people
who are striving to attain and sustain recovery; build resilience; and work, learn, live,
and participate fully in their communities.

The first and foremost domain is abstinence from drug use and alcohol abuse or
decreased symptoms of mental illness with improved functioning. Four domains focus
on resilience and sustaining recovery. These include getting and keeping a job or
enrolling and staying in school; decreased involvement with the criminal justice system;
securing a safe, decent, and stable place to live; and social connectedness to and
support from others in the community such as family, friends, co-workers, and
classmates. Two domains look directly at the treatment process itself in terms of
available services and services provided. One measure is increased access to services
for both mental disorders and substance abuse. Another is increased retention in
services for substance abuse or decreased inpatient hospitalizations for mental health
treatment. The final three domains examine the quality of services provided. These
include client perception of care, cost-effectiveness, and use of evidenced-based
practices in treatment.

This year as opposed to last year significantly increased numbers of States have
reported on NOMs domains for both mental health and substance use programs:

State Mental Health Agencies reported the following outcomes for services provided
during 2004:

   ·   For the 42 States that reported data in the Employment Domain, 21 percent of
       the mental health consumers were in competitive employment. (This is an
       expansion of the reporting base by two States.)
   ·   For the 39 States that reported data in the Housing Domain, 75 percent of the
       mental health consumers were living in private residences. (This is an expansion
       of the reporting base by 11 States.)
   ·   For the 39 States that reported data in the Retention Domain, only 9 percent of
       the mental health patients returned to a State hospital within 30 days of State
       hospital discharge. (This is an expansion of the reporting base by nine States.)
   ·   For the 44 States that reported data in the Perception of Care Domain, 71
       percent of the mental health consumers reported that, as a direct result of the
       mental health services they received, they were doing better. (This is an
       expansion of the reporting base by one State.)

Substance Abuse Treatment Services: There are 60 States (the term includes States,
Territories, the District of Columbia, and the Red Lake Indian Tribe of Minnesota)



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eligible to receive Substance Abuse Prevention and Treatment Block Grant (SAPTBG)
funds. Preliminary data from the Fiscal Year 2006 SAPTBG application, which reports
2003 data, indicate that all States fall within the current cost bands for cost per
admission by level of care. During the most recent year for which SAPTBG data are
available, the number of persons served (approximately 2 million) was derived from a
variety of sources. Forty-nine of the State counts were based upon a statewide unique
client ID, and 11 were based upon State estimates. The new State Outcomes
Measurement and Management System (SOMMS) will provide the opportunity to
remedy this inconsistency.

State Substance Abuse Agencies reported the following outcomes for services provided
during 2003:

   ·   For the 32 States that reported data in the Abstinence from Drug/Alcohol Use
       Domain for alcohol, all identified improvements in client abstinence from alcohol
       and other substances.
   ·   Similarly for the 30 States that reported data in the Abstinence from Drug/Alcohol
       Use Domain for drug use, all identified improvements in client abstinence.
       (Overall the number of reporting States increased by 21 for alcohol and 19 for
       drug use.)
   ·   For the 34 States that reported data in the Employment Domain, 31 of 34
       identified improvements in client employment. (This is an expansion of 18 in the
       reporting base for this domain.)
   ·   For the 22 States that reported in the Criminal Justice Domain, 21 reported a
       reduction in arrests. (For this domain, the reporting base increased by 14 States.)
   ·   For the 29 States that reported data in the Housing Domain, 26 of 29 identified
       improvements in stable housing for clients.

Next steps for Data Quality Improvements:

Data for reporting on these measures come from the States. States are supported in
their efforts by SAMHSA with infrastructure, technical assistance, and financial support
through the new SOMMS. Since my report last year, 31 State substance abuse
agencies have been enrolled in this program and the balance is expected to come in
over the next year. Over the next 2 years through this new system SAMHSA in
partnership with the States will:

   ·   Standardize operational definitions and outcome measures, and link records to
       support pre- and post-service comparisons.
   ·   Develop benchmarking strategies to determine acceptable levels of outcomes.
   ·   Produce routine management reports to direct our technical assistance and
       science-to-services program to implement interventions designed to result in
       improved outcomes.
   ·   Reduce the cycle time from data collection to data reporting to SAMHSA to data
       availability for performance management.




May 2006                                                                                   2
   ·   Achieve full State reporting by the end of fiscal year 2007. In the interim, each
       year more States will report with standard definitions until all States are on board.
       While each State is at a different stage of readiness and some of the measures
       themselves are still in development, ultimately, we will be able to report at the
       State level consistent, cross-year data allowing us to examine the impact of
       programs and changes over time. The State-developed implementation plans for
       implementing these improvements to data are available on the NOMs web page.

NOMS outcomes for substance abuse prevention are drawn primarily from SAMHSA's
National Survey on Drug Use and Health (NSDUH). This annual survey collects data
among members of U.S. households aged 12 or older, including substance use in the
past 30 days, perceived risk of use, and age at first use--all information that provides
benchmarks for the Abstinence from Drug/Alcohol Use Domain. Nationally, combined
data for 2003 and 2004 show that among persons aged 12 to 17:

   ·   Eleven percent reported binge alcohol use in the past 30 days; however, 38
       percent perceived a great risk of harm from having five or more drinks of an
       alcoholic beverage once or twice a week.
   ·   Eight percent reported marijuana use in the past 30 days; however, 35 percent
       perceived a great risk of harm from smoking marijuana once a month.
   ·   Six percent were first-time marijuana users.

During the past year SAMHSA's Center for Substance Abuse Prevention enrolled all the
States into its State Outcomes and Epidemiology Workgroup program through either the
State Prevention Framework Incentive Grant or by contract. This support will enable the
States to acquire and analyze State-level data along with the NSDUH data to both direct
and assess the impact of prevention programs at the local level.

Baseline NOMs reports completed for SAMHSA's Program Priority Areas for the
discretionary programs:

During the past year we have assessed the applicability of the data available in our
national data sets to establish baselines and NOMs reporting for our discretionary grant
programs. These reports are available from the NOMs web page. They establish the
importance of these areas to the well-being of the Nation and also have led us to
identify gaps in our data that must be addressed.

The achievements of the past year demonstrate a strong partnership in an enormous
undertaking and reflect solid, early progress. Once the established 3­year
implementation phase with our State partners is complete, SAMHSA will have a much
clearer reporting mechanism for Congress and the taxpayers on the effectiveness of
their investment in our programs. Critically, this will allow SAMHSA to make decisions
based on the best data possible to improve services for the people we serve.

I look forward to implementing SOMMS, which will bring the NOMs data collection to its
full potential. I remain committed to good fiscal stewardship and to making it possible for



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even more Americans who battle addiction and struggle with mental illness to live, work,
learn, and enjoy themselves in communities across the nation.

The following information is the second web page release, which reflects the data
gathered from reporting States thus far. I am pleased to share the following highlights
with you.

Charles G. Curie, M.A., A.C.S.W.




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