Substance Abuse And Mental Health Services Administration:

Planning for Program Changes and Future Workforce Needs Is Incomplete

GAO-04-683: Published: Jun 4, 2004. Publicly Released: Jul 6, 2004.

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The Substance Abuse and Mental Health Services Administration (SAMHSA) is the lead federal agency responsible for improving the quality and availability of prevention and treatment services for substance abuse and mental illness. The upcoming reauthorization review of SAMHSA will enable the Congress to examine the agency's management of its grant programs and plans for converting its block grants to performance partnership grants, which will hold states more accountable for results. GAO was asked to provide the Congress with information about SAMHSA's (1) strategic planning efforts, (2) efforts to manage its workforce, and (3) partnerships with state and community-based grantees.

SAMHSA has not completed key planning efforts to ensure that it can effectively manage its programs. The agency has operated without a strategic plan since October 2002, and although SAMHSA officials are drafting a plan, they do not know when it will be completed. SAMHSA developed long-term goals and a set of priority issues that provide some guidance for the agency's activities, but they are not a substitute for a strategic plan. In particular, they do not identify the approaches and resources needed to achieve the agency's long-term goals and the desired results against which the agency's programs can be measured. SAMHSA also has not fully developed strategies to ensure it has the appropriate staff to manage the agency's programs. Although the proportion of SAMHSA's staff eligible to retire is increasing, the agency has not developed a detailed succession strategy to prepare for the loss of essential expertise and to ensure that the agency continues to have the ability to fill key positions. In addition, the proposed performance partnership grants will change the way SAMHSA administers its largest grant programs, but the agency has not completed hiring and training strategies to ensure that its workforce will have the skills needed to administer the grants. Finally, SAMHSA's system for evaluating staff performance does not distinguish between acceptable and outstanding performance, and the agency does not assess staff performance in relation to specific competencies--practices that would help reinforce individual accountability for results. SAMHSA has opportunities to improve its partnerships with state and community-based grantees. For example, grantees objected to SAMHSA's practice of rejecting discretionary grant applications that do not comply with administrative requirements--such as those that exceed page limitations--without reviewing them for merit. Rejecting applications solely on administrative grounds potentially prevents SAMHSA from supporting the most effective programs. SAMHSA's recent changes to the review process should reduce such rejections, but have not eliminated them. State officials are also concerned that SAMHSA has not finalized the performance data that states would be required to report under the proposed performance partnership grants. To comply, states will need to change their data systems, but they cannot complete these changes until SAMHSA finalizes the requirements. The Congress directed SAMHSA to submit a plan by October 2002 describing the final data reporting requirements and any legislative changes needed to implement the grants, but SAMHSA has not yet completed the plan. This delay could prevent the agency from meeting its current timetable for implementing the mental health and substance abuse performance partnership grants in fiscal years 2005 and 2006, respectively.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: In June 2005, SAMHSA issued "A REPORT REQUIRED BY CONGRESS ON PERFORMANCE PARTNERSHIPS: A Discussion of SAMHSA's Efforts to Increase Accountability Based on Performance in Its Block Grant Program by Instituting National Outcome Measures."

    Recommendation: To improve SAMHSA's management of its programs, promote the effective use of its resources, and increase program accountability, the Administrator of SAMHSA should expedite completion of its plan for the Congress providing information on the agency's proposal for implementing the performance partnership grants and any legislative changes that must precede their implementation.

    Agency Affected: Department of Health and Human Services: Public Health Service: Substance Abuse and Mental Health Services Administration

  2. Status: Closed - Implemented

    Comments: On February 2, 2005, SAMHSA reported undertaking a series of actions to ensure state project officers possessed the skills necessary to implement increased accountability based on performance in the block grant programs, including in-service staff training sessions and a project officer competency checklist. Subsequently, in August 2006, SAMHSA indicated that (1) from January 2005 through September 2005, the Center for Substance Abuse Treatment (CSAT) had completed all core training, and by March 2006 it had conducted training in statistical methods and performance management for all staff; and (2) the Center for Substance Abuse Prevention had developed a comprehensive training strategy for its project officers. Regarding hiring strategies, in October 2006, SAMHSA indicated that CSAT had revised its position descriptions, but it could not provide an overall final asessment of the results, but indicated that almost all staff had received mid-year evaluations that showed satisfactory results.

    Recommendation: To improve SAMHSA's management of its programs, promote the effective use of its resources, and increase program accountability, the Administrator of SAMHSA should complete hiring and training strategies, and assess the results, to ensure that the agency's workforce has the appropriate expertise to implement performance partnership grants.

    Agency Affected: Department of Health and Human Services: Public Health Service: Substance Abuse and Mental Health Services Administration

  3. Status: Closed - Implemented

    Comments: On February 2, 2005, SAMHSA noted that to further refine the future needs of the organization, that it had (1)analyzed its workforce data to more accurately predict anticipated retirements and future staffing needs, (2)reviewed its strategic direction and its revised management objectives to clarify the future needs of the organization; and (3) conducted focus groups to address specific competencies needed to ensure continuity for all key positions in the organization. SAMHSA also indicated that it had launched a leadership development program in the summer 2004, which it described as the cornerstone of its succession planning and human capital strategy.

    Recommendation: To improve SAMHSA's management of its programs, promote the effective use of its resources, and increase program accountability, the Administrator of SAMHSA should develop a detailed succession strategy to ensure SAMHSA has the appropriate workforce to carry out the agency's mission.

    Agency Affected: Department of Health and Human Services: Public Health Service: Substance Abuse and Mental Health Services Administration

  4. Status: Closed - Not Implemented

    Comments: On February 2, 2005, SAMHSA reported that it found the remedy proposed by GAO to be unwarranted. SAMHSA indicated that in FY 2004, it had improved its procedures to ensure that applications are subjected to peer review whenever possible, and that the new procedures had yielded a substantial decrease in the percentage of applications excluded from peer review. According to SAMHSA, the exclusion rate declined from about 19 percent in FY 2003 to about 6 percent in FY 2004. SAMHSA reported that it anticipated that the percentages would decline further with additional clarification and publicity of its requirements to prospective applicants.

    Recommendation: To improve SAMHSA's management of its programs, promote the effective use of its resources, and increase program accountability, the Administrator of SAMHSA should develop a procedure that gives applicants whose discretionary grant application contains administrative errors an opportunity to revise and resubmit their application within an established time frame.

    Agency Affected: Department of Health and Human Services: Public Health Service: Substance Abuse and Mental Health Services Administration

 

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