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Planning for Program Changes and Future Workforce Needs Is Incomplete' 
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Report to the Chairman, Committee on Health, Education, Labor, and 
Pensions, U.S. Senate:

United States General Accounting Office:

GAO:

June 2004:

Substance Abuse and Mental Health Services Administration:

Planning for Program Changes and Future Workforce Needs Is Incomplete:

GAO-04-683:

GAO Highlights:

Highlights of GAO-04-683, a report to the Chairman, Committee on 
Health, Education, Labor, and Pensions, U.S. Senate:  

Why GAO Did This Study:

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. 

What GAO Found:

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.

What GAO Recommends:

We are recommending that the Administrator of SAMHSA: (1) develop a 
detailed succession strategy, (2) ensure that the agency’s workforce 
has the appropriate expertise to implement the performance partnership 
grants, (3) develop a procedure to allow applicants for discretionary 
grants to correct administrative errors in applications and resubmit 
them, and (4) expedite completion of the plan for the Congress 
providing information on the performance partnership grants. SAMHSA 
said that each recommendation addresses an area that the agency has 
identified for further action or improvement.

www.gao.gov/cgi-bin/getrpt?GAO-04-683.

To view the full product, including the scope and methodology, click on 
the link above. For more information, contact Leslie Aronovitz at (312) 
220-7600 or aronovitzl@gao.gov.

[End of section]

Contents:

Letter:

Results in Brief:

Background:

SAMHSA's Strategic Planning Efforts Are Incomplete:

SAMHSA's Efforts to Manage Its Workforce Lack Important Elements:

SAMHSA Is Taking Action to Improve Its Partnerships with Federal 
Agencies and Departments:

SAMHSA Could More Effectively Manage Partnerships with State and Local 
Grantees:

Conclusions:

Recommendations for Executive Action:

Agency Comments:

Appendix I: Scope and Methodology:

Appendix II: SAMHSA's Strategic Workforce Plan Goals and Strategies, by 
Focus Area:

Appendix III: Comments from the Department of Health and Human 
Services:

Tables:

Table 1: Purpose Statements of SAMHSA's Centers:

Table 2: SAMHSA's Priority Issues and Priority Principles:

Table 3: Selected Collaborative Initiatives between SAMHSA and Its 
Federal Partners:

Table 4: Fiscal Year 2003 Interagency Agreements between SAMHSA and Its 
Federal Partners:

Table 5: Information on Selected Discretionary Grant Programs:

Figures:

Figure 1: SAMHSA Organization Chart and Staffing Levels, Fiscal Year 
2003:

Figure 2: SAMHSA's Budget Devoted to Block Grants and Other Activities, 
Fiscal Year 2003:

Abbreviations:

HHS: Department of Health and Human Services: 
SAMHSA: Substance Abuse and Mental Health Services Administration:

United States General Accounting Office:

Washington, DC 20548:

June 4, 2004:

The Honorable Judd Gregg: 
Chairman: 
Committee on Health, Education, Labor, and Pensions: 
United States Senate:

Dear Mr. Chairman:

Mental illness and substance abuse are major national problems. It is 
estimated that more than 44 million Americans have a mental 
disorder,[Footnote 1] 22 million Americans have a substance abuse 
problem,[Footnote 2] and 7 to 10 million Americans have co-occurring 
mental health and substance abuse disorders.[Footnote 3] Substance 
abuse and mental health disorders are treatable, and services can help 
relieve people's symptoms and reduce the likelihood of their developing 
future problems.

The Department of Health and Human Services' (HHS) 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. In fiscal year 2003, SAMHSA managed a budget of $3.1 billion; 
its staff of about 500 full-time-equivalent employees was one of the 
smallest among HHS agencies. SAMHSA's budget primarily supported grants 
to states and local agencies to provide substance abuse and mental 
health services.[Footnote 4] The agency largely depends on the work of 
these grantees to carry out its mission--to help people recover from 
substance abuse and mental illness and develop the resilience to cope 
with problems that can lead to them. SAMHSA also carries out its 
mission through collaborations with other federal agencies and 
departments.

The upcoming legislative reauthorization of SAMHSA provides the 
Congress with an opportunity to review how the agency manages its grant 
programs. Furthermore, examining SAMHSA's relationships with state and 
local partners is particularly important as SAMHSA and the Congress 
prepare to change the way the agency administers its largest grant 
programs, the substance abuse and mental health block grants.[Footnote 
5] In response to a requirement in the Children's Health Act of 
2000,[Footnote 6] SAMHSA is developing plans to transform its current 
block grants. The new grants--performance partnership grants--would 
give states greater flexibility in how they spend funds, while holding 
them more accountable for achieving specific results. In preparation 
for SAMHSA's legislative reauthorization, you asked us to provide 
information on SAMHSA's (1) strategic planning efforts, (2) efforts to 
manage its workforce, (3) collaborations with federal agencies and 
departments, and (4) partnerships with state and community-based 
grantees.

To conduct our work, we analyzed pertinent agency documents and 
interviewed officials from SAMHSA. We also interviewed officials from 
selected federal agencies and departments that are engaged in 
collaborative efforts with SAMHSA. For information on SAMHSA's 
partnerships with state grantees, we interviewed officials from the 
mental health or substance abuse agency in 10 states--California, 
Colorado, Connecticut, Iowa, Massachusetts, Mississippi, Montana, 
South Dakota, Texas, and Virginia. We selected these states on the 
basis of variation in their geographic location, the size of their 
fiscal year 2003 mental health or substance abuse block grant award, 
the number of other grant awards they received in fiscal year 2002, and 
their involvement in SAMHSA initiatives to improve states' ability to 
report mental health and substance abuse data. We also interviewed 
representatives of selected community-based organizations that 
received grants from SAMHSA. We conducted our work from July 2003 
through May 2004 in accordance with generally accepted government 
auditing standards. (For additional information on our methodology, see 
app. I.)

Results in Brief:

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. As part of 
its strategic planning process, SAMHSA developed three long-term goals-
-promoting accountability, enhancing service capacity, and improving 
the effectiveness of substance abuse and mental health services. SAMHSA 
also developed a set of 11 priority issues--such as co-occurring mental 
health and substance abuse disorders--to guide the agency's activities. 
While the goals and priority issues provide some guidance to the 
agency, they are not a substitute for a strategic plan. In particular, 
they do not identify the approaches 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 its programs. SAMHSA is implementing a 
strategic workforce plan that calls for the development of a skilled 
workforce and efficient work processes, but 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. The proportion of SAMHSA's staff 
eligible to retire is increasing--it is expected to be 25 percent in 
fiscal year 2005--and future retirements and attrition could leave the 
agency without leadership continuity and the appropriate workforce to 
effectively carry out its programs. In addition, the agency has not 
fully developed hiring and training plans to ensure that its workforce 
will have the necessary expertise to administer the proposed 
performance partnership grants. Finally, SAMHSA recently implemented a 
performance management system that is intended to hold staff 
accountable for results by linking staff expectations with the agency's 
long-term goals. However, SAMHSA's system 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.

SAMHSA has taken steps to improve its collaborations with other federal 
agencies and departments. To jointly fund grant programs with its 
federal partners, SAMHSA frequently uses interagency agreements, which 
allow funds to be transferred between agencies. While interagency 
agreements can streamline the grantmaking process by enabling a single 
agency to administer a jointly funded grant program, SAMHSA's process 
for approving the agreements has been lengthy and has delayed the 
awarding of grants. To improve this process, SAMHSA recently 
implemented new procedures for reviewing and approving interagency 
agreements. It is too early to know how SAMHSA's new policies will 
affect the efficiency of its approval process. SAMHSA is also taking 
steps to better coordinate with its federal partners to provide states 
and community-based organizations with information on effective mental 
health and substance abuse practices. For example, SAMHSA recently 
initiated the Science to Service partnership to better integrate the 
National Institutes of Health's research on effective practices with 
the services funded by SAMHSA.

SAMHSA also 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 applications that 
exceed the specified page limitation--without reviewing them for merit. 
These grants are awarded on a competitive basis to a limited number of 
eligible applicants, and rejecting applications solely on 
administrative grounds potentially prevents SAMHSA from supporting the 
most effective programs. SAMHSA recently changed its review process, 
which agency officials believe will reduce the number of such 
rejections. However, some applications continue to be rejected for 
administrative reasons. In addition, state officials are concerned that 
SAMHSA has not finalized the performance data that states would report 
under the proposed performance partnership grants. To comply with the 
proposed grant requirements, states will need to change their data 
systems, but they cannot complete these changes until SAMHSA finalizes 
the requirements. In 2000, the Congress directed SAMHSA to submit a 
plan by October 2002 describing any legislative changes needed to 
transform the block grants into performance partnership grants and the 
final data reporting requirements. SAMHSA has not yet completed the 
plan, and this delay could prevent the agency from meeting its current 
timetable for implementing the mental health and substance abuse 
grants--in fiscal years 2005 and 2006, respectively.

We are recommending that the Administrator of SAMHSA (1) develop a 
detailed succession strategy, (2) ensure that the agency's workforce 
has the appropriate expertise to implement the performance partnership 
grants, (3) develop a procedure to allow applicants for discretionary 
grants to correct administrative errors in applications and resubmit 
them, and (4) expedite completion of the plan for the Congress 
providing information on the performance partnership grants.

In commenting on a draft of this report, SAMHSA said that overall, it 
generally agrees with the report's findings and that each 
recommendation addresses an area that the agency has identified for 
further action or improvement.

Background:

In October 1992, the Congress established SAMHSA to strengthen the 
nation's health care delivery system for the prevention and treatment 
of substance abuse and mental illnesses.[Footnote 7] SAMHSA has three 
centers that carry out its programmatic activities: the Center for 
Mental Health Services, the Center for Substance Abuse Prevention, and 
the Center for Substance Abuse Treatment. (See table 1 for a 
description of each center's purpose.) The centers receive support from 
SAMHSA's Office of the Administrator; Office of Program Services; 
Office of Policy, Planning, and Budget; and Office of Applied Studies. 
The Office of Program Services oversees the grant review process and 
provides centralized administrative services for the agency; the Office 
of Policy, Planning, and Budget develops the agency's policies, manages 
the agency's budget formulation and execution, and manages agencywide 
strategic and program planning activities; and the Office of Applied 
Studies gathers, analyzes, and disseminates data on substance abuse 
practices in the United States, which includes administering the annual 
National Survey on Drug Use and Health--a primary source of information 
on the prevalence, patterns, and consequences of drug and alcohol use 
and abuse in the country[Footnote 8].

Table 1: Purpose Statements of SAMHSA's Centers:

Center: Center for Mental Health Services; 
Purpose: To improve the availability and accessibility of high-quality 
community-based services for people with, or at risk for, mental 
illnesses.

Center: Center for Substance Abuse Prevention; 
Purpose: To bring effective substance abuse prevention to every 
community, nationwide.

Center: Center for Substance Abuse Treatment; 
Purpose: To promote the availability and quality of community-based 
substance abuse treatment services for individuals and families who 
need them.

Source: GAO analysis of SAMHSA documents.

[End of table]

In fiscal year 2003, SAMHSA's staff totaled 504 full-time-equivalent 
employees, a decrease from 563 in fiscal year 1999. Thirteen of the 
employees were in the Senior Executive Service, and the average grade 
of SAMHSA's general schedule workforce was 12.5--up from 11.7 in fiscal 
year 1999. In addition, 25 of the employees were members of the U.S. 
Public Health Service Commissioned Corps.[Footnote 9] SAMHSA's program 
staff are almost evenly divided among its three centers (see fig. 1), 
and all are located in the Washington, D.C., metropolitan area.

Figure 1: SAMHSA Organization Chart and Staffing Levels, Fiscal Year 
2003:

[See PDF for image]

Note: "Staff" refers to full-time-equivalent employees.

[End of figure]

SAMHSA's budget increased from about $2 billion in fiscal year 1992 to 
about $3.1 billion in fiscal year 2003. SAMHSA uses most of its budget 
to fund grant programs that are managed by its three centers. (See fig. 
2.) In fiscal year 2003, 68 percent of SAMHSA's budget funded the 
Substance Abuse Prevention and Treatment Block Grant ($1.7 billion) and 
the Community Mental Health Services Block Grant ($437 million). The 
remaining portion of SAMHSA's budget primarily funded other grants; $74 
million (2.4 percent) of its fiscal year 2003 budget supported program 
management.[Footnote 10]

Figure 2: SAMHSA's Budget Devoted to Block Grants and Other Activities, 
Fiscal Year 2003:

[See PDF for image]

Note: In addition to these funds, SAMHSA received $74.2 million from 
HHS to help pay for its national surveys and its data, technical 
assistance, and evaluation activities.

[End of figure]

Administration of SAMHSA's Block and Discretionary Grants:

SAMHSA's major activity is to use its grant programs to help states and 
other public and private organizations provide substance abuse and 
mental health services. For example, the substance abuse block grant 
program gives all states a funding source for planning, carrying out, 
and evaluating substance abuse services. States use their substance 
abuse block grants to fund more than 10,500 community-based 
organizations. Similarly, the mental health block grant program 
supports a broad spectrum of community mental health services for 
adults with serious mental illness and children with serious emotional 
disorders.[Footnote 11]

In December 2002, SAMHSA released for public comment its initial 
proposal for how it will transform the substance abuse and mental 
health block grants into performance partnership grants. In 
administering the block grants, the agency currently holds states 
accountable for complying with administrative and financial 
requirements, such as spending a specified percentage of funds on 
particular services or populations. According to SAMHSA's proposal, the 
new grants will give states more flexibility to meet the needs of their 
population by removing certain spending requirements. At the same time, 
the grants will hold states accountable for achieving specific goals 
related to the availability and effectiveness of mental health and 
substance abuse services. For example, SAMHSA has proposed that it 
would waive the current requirement that a state use a certain 
percentage of its substance abuse block grant funds for HIV services if 
that state can show a reduction of HIV transmissions among the 
population with a substance abuse problem.[Footnote 12] The Children's 
Health Act of 2000 required SAMHSA to submit a plan to the Congress by 
October 2002 describing the flexibility the performance partnership 
grants would give the states, the performance measures that SAMHSA 
would use to hold states accountable, the data that SAMHSA would 
collect from states, definitions of the data elements, obstacles to 
implementing the grants and ways to resolve them, the resources needed 
to implement the grants, and any federal legislative changes that would 
be necessary.[Footnote 13]

In addition to the block grants that SAMHSA awards to all states, the 
agency awards grants on a competitive basis to a limited number of 
eligible applicants. These discretionary grants help public and private 
organizations develop, implement, and evaluate substance abuse and 
mental health services. In fiscal year 2003, the agency funded 73 
discretionary grant programs, the largest of which was the $98.1 
million Children's Mental Health Services Program. This program helps 
grantees integrate and manage various social and medical services 
needed by children and adolescents with serious emotional disorders.

Discretionary grant applications submitted to SAMHSA go through several 
stages of review. When SAMHSA initially receives grant applications, it 
screens them for adherence to specific formatting and other 
administrative requirements. Applications that are rejected--or 
screened out--at this stage receive no further review. Applications 
that move on are reviewed on the basis of their scientific and 
technical merit by an initial review group[Footnote 14] and then by one 
of SAMHSA's national advisory councils.[Footnote 15] The councils, 
which ensure that the applications support the mission and priorities 
defined by SAMHSA or the specific center, must concur with the scores 
given to the applications by the initial review group. On the basis of 
the ranking of these scores given by the peer reviewers and on other 
criteria posted in the grant announcement, such as geographic location, 
SAMHSA program staff decide which grant applications receive funding. 
Center directors and grants management officers must approve award 
decisions that differ from the ranking of priority scores, and SAMHSA's 
administrator approves all final award decisions.

SAMHSA's oversight of its block and discretionary grants consists 
primarily of reviews of independent audit reports, on-site reviews, and 
reviews of grant applications. SAMHSA's Division of Grants 
Management[Footnote 16] provides grant oversight, which includes 
reviewing the results of grantees' annual financial audits that are 
required by the Single Audit Act.[Footnote 17] In general, these audits 
are designed to determine whether a grantee's financial statements are 
fairly presented and grant funds are managed in accordance with 
applicable laws and program requirements. Furthermore, SAMHSA is 
statutorily required to conduct on-site reviews to monitor block grant 
expenditures in at least 10 states each fiscal year.[Footnote 18] The 
reviews examine states' fiscal monitoring of service providers and 
compliance with block grant requirements, such as requirements to 
maintain a certain level of state expenditures for drug abuse treatment 
and community mental health services--referred to as maintenance of 
effort.[Footnote 19] In addition, SAMHSA project officers--grantees' 
main point of contact with SAMHSA--monitor states' compliance with 
block grant requirements through their review of annual block grant 
applications. For example, in the substance abuse block grant 
application, states report how they spent funds made available during a 
previous fiscal year and how they intend to obligate funds being made 
available in the current fiscal year; project officers review this 
information to determine if states have complied with statutory 
requirements. For discretionary grants, project officers monitor 
grantees' use of funds through several mechanisms, including quarterly 
reports, site visits, conference calls, and regular meetings. The 
purpose of monitoring both block and discretionary grants is to ensure 
that grantees achieve program goals and receive any technical 
assistance needed to improve their delivery of substance abuse and 
mental health services.

Selected Federal Agencies and Departments That Collaborate with SAMHSA:

SAMHSA has partnerships with every HHS agency and 12 federal 
departments and independent agencies that fund substance abuse and 
mental health programs and activities. For example, within HHS, the 
Centers for Disease Control and Prevention and the Health Resources and 
Services Administration have responsibility for improving the 
accessibility and delivery of mental health and substance abuse 
services, and the National Institutes of Health funds research on 
numerous topics related to substance abuse and mental health.[Footnote 
20] The Departments of Education, Housing and Urban Development, 
Justice, and Veterans Affairs fund substance abuse and mental health 
initiatives to help specific populations, such as children and homeless 
people.[Footnote 21] In addition, the White House Office of National 
Drug Control Policy is responsible for overseeing and coordinating 
federal, state, and local drug control activities. Specifically, the 
office gives federal agencies guidance for preparing their annual 
budgets for activities related to reducing illicit drug use. It also 
develops substance abuse profiles of states and large cities, which 
contain statistics related to drug use and information on federal 
substance abuse prevention and treatment grants awarded to that state 
or city.

SAMHSA's Strategic Planning Efforts Are Incomplete:

SAMHSA has operated without a strategic plan since October 
2002.[Footnote 22] Although agency officials are in the process of 
drafting a plan that covers fiscal years 2004 through 2009 and expect 
to have it ready for public comment in the fall of 2004, they do not 
know when they will issue a final strategic plan.

As part of its strategic planning process, which began in fiscal year 
2002, SAMHSA developed three long-term goals for the agency--promoting 
accountability, enhancing service capacity,[Footnote 23] and improving 
the effectiveness of substance abuse and mental health services. 
SAMHSA's management has also identified 11 priority issues to guide the 
agency's activities and resource allocation[Footnote 24] and 10 
priority principles that agency officials are to consider when they 
develop policies and programs related to these issues. (See table 2 for 
a list of SAMHSA's priority issues and priority principles.) For 
example, when SAMHSA develops grant programs to increase substance 
abuse treatment capacity--a priority issue--staff are to consider the 
priority principle of how the programs can be implemented in rural 
settings. To ensure that the priority issues play a central role in the 
work of its three centers, SAMHSA established work groups for all the 
priority issues that include representation from at least two centers. 
The work groups are to make recommendations to SAMHSA's leadership 
about funding for specific programs and to develop cross-center 
initiatives.

Table 2: SAMHSA's Priority Issues and Priority Principles:

Issues: 
Co-occurring mental health and substance abuse disorders; 
Substance abuse treatment capacity; 
Seclusion and restraint; 
Strategic prevention framework; 
Children and families; 
Mental health system transformation; 
Disaster readiness and response; 
Homelessness; 
Aging; 
HIV/AIDS and hepatitis; 
Criminal justice; 


Principles: 
Science to services/evidence-based practices; 
Data for performance measurement and management; 
Collaboration with public and private partners; 
Recovery/reducing stigma and barriers to services; 
Cultural competency/eliminating disparities; 
Community and faith-based approaches; 
Trauma and violence; 
Financing strategies and cost effectiveness; 
Rural and other specific settings; 
Workforce development.

Source: GAO analysis of SAMHSA documents.

[End of table]

Although SAMHSA officials consider the agency's set of priority issues 
and priority principles a valuable planning and management tool, it 
lacks important elements that a strategic plan would provide.[Footnote 
25] For example, SAMHSA's priorities do not identify the approaches and 
resources needed to achieve the long-term goals; the results expected 
from the agency's grant programs and a timetable for achieving those 
results; and an assessment of key external factors, such as the actions 
of other federal agencies, that could affect SAMHSA's ability to 
achieve its goals. Without a strategic plan that includes the expected 
results against which the agency's efforts can be measured, it is 
unclear how the agency or the Congress will be able to assess the 
agency's progress toward achieving its long-term goals or the adequacy 
and appropriateness of SAMHSA's grant programs. Such assessments would 
help SAMHSA determine whether it needs to eliminate, create, or 
restructure any grant programs or activities. The priority issue work 
groups are developing multiyear action plans that could support 
SAMHSA's strategic planning efforts, because the plans are expected to 
include measurable performance goals, action steps to meet those goals, 
and a description of external factors that could affect program 
results. SAMHSA officials expect to approve the action plans by June 
30, 2004, and include them as a component of the draft strategic plan.

SAMHSA's Efforts to Manage Its Workforce Lack Important Elements:

SAMHSA's strategic workforce planning efforts lack key strategies to 
ensure appropriate staff will be available to manage the agency's 
programs. Specifically, SAMHSA has not developed a detailed succession 
strategy to prepare for the loss of essential expertise and to ensure 
that the agency can continue to fill key positions. In addition, the 
agency has not fully developed hiring and training strategies to ensure 
that its project officers can administer the proposed performance 
partnership grants. SAMHSA has, however, taken steps to improve project 
officers' expertise for managing the current block grants and to 
increase staff effectiveness by improving the efficiency of its work 
processes. While SAMHSA recently implemented a performance management 
system that links staff expectations with the agency's long-term goals, 
other aspects of the system do not reinforce individual accountability.

SAMHSA Has Not Fully Planned for Future Workforce Needs, but Has Taken 
Steps to Improve Staff Effectiveness:

SAMHSA's strategic workforce planning lacks key elements to ensure that 
the agency has staff with the appropriate expertise to manage its 
programs. The goal of strategic workforce planning is to develop long-
term strategies for acquiring, developing, and retaining staff needed 
to achieve an organization's mission and programmatic goals. SAMHSA is 
implementing a strategic workforce plan--developed for fiscal years 
2001 through 2005--that identifies the need to strategically and 
systematically recruit, hire, develop, and retain a workforce with the 
capacity and knowledge to achieve the agency's mission. SAMHSA 
developed the plan to improve organizational effectiveness and make the 
agency an "employer of choice," and the plan calls for development of 
an adequately skilled workforce and efficient work processes. (See app. 
II for additional information on SAMHSA's strategic workforce plan.) 
The plan specifically outlines the need to engage in succession 
planning to prepare for the loss of essential expertise and to 
implement strategies to obtain and develop the competencies that the 
agency needs.[Footnote 26]

SAMHSA did not include a succession strategy in its strategic workforce 
plan, and the agency has not yet developed such a strategy. As we have 
previously reported, succession planning is important for strengthening 
an agency's workforce by ensuring an ongoing supply of successors for 
leadership and other key positions.[Footnote 27] SAMHSA officials told 
us the agency has begun to engage in succession planning. They also 
noted that recent retirement and attrition rates have been moderate--
about 5 percent and 10 percent, respectively, in fiscal year 2003--and 
that the agency's small size allows them to identify those likely to 
retire and to fill key vacancies as they occur. However, the proportion 
of SAMHSA's workforce eligible to retire is expected to rise from 19 
percent in fiscal year 2003 to 25 percent in fiscal year 2005, and 
careful planning could help SAMHSA prepare for the loss of essential 
expertise.

Another shortcoming in SAMHSA's strategic workforce planning is that 
the agency has not fully developed hiring and training strategies to 
ensure that its project officers will have the appropriate expertise to 
manage the proposed performance partnership grants. The changes in the 
block grant will alter the relationship between SAMHSA and the states, 
requiring project officers to negotiate specific performance goals and 
monitor states' progress towards these goals. SAMHSA's block grant 
reengineering team[Footnote 28] found that, to carry out these 
responsibilities, project officers will need training in performance 
management; elementary statistics; and negotiation, advocacy, and 
mediation. SAMHSA expected to have a training plan by late May 2004, 
but has not established a firm date by which the training will be 
provided.[Footnote 29] As SAMHSA develops the training plan, it will be 
important for the agency to consider how it will implement and evaluate 
the training, including how it will assess the effect of the training 
on staff's development of needed skills and competencies.[Footnote 30]

In addition, the reengineering team recommended that the agency use 
individualized staff development plans for project officers to ensure 
that they acquire necessary skills. SAMHSA expects to have the 
individual development plans in place by the end of fiscal year 2004. 
The team also recommended that the agency develop new job descriptions 
to recruit new staff. SAMHSA has developed job descriptions that 
identify the responsibilities all project officers will have to meet 
and is using those descriptions in its recruitment efforts.

SAMHSA has initiated efforts to improve the ability of project officers 
to assist grantees with the current block grants. For example, SAMHSA 
officials told us that the agency has made an effort to hire more 
project officers with experience working in state mental health and 
substance abuse systems. The agency is also expanding project officers' 
training on administrative policies and procedures and is planning to 
add a discussion of block grant procedures to its on-line policy 
manual. These efforts should help respond to the block grant 
reengineering team's finding that project officers require additional 
training in substance abuse prevention and treatment and block grant 
program requirements. They should also help address the concerns of 
state officials who told us that project officers for the block grants 
have not always had sufficient background in mental health or substance 
abuse services or have provided confusing or incorrect information on 
grant requirements. For example, one state received conflicting 
information from its project officer about the percentage of its 
substance abuse block grant that it was required to spend for HIV/AIDS 
services. Similarly, according to another state official, a project 
officer provided unclear guidance on how to submit a request to waive 
the mental health block grant's maintenance of effort requirement, 
which resulted in the state having to resubmit the request.

To meet the goal in its workforce plan of increasing staff 
effectiveness, SAMHSA is taking steps to improve the agency's work 
processes. For example, agency officials expect to reduce the amount of 
time and effort that staff devote to preparing grant announcements by 
issuing 4 standard grant announcements for its discretionary grant 
programs,[Footnote 31] instead of the 30 to 40 issued annually in 
previous years. SAMHSA officials estimate that the 4 standard 
announcements will encompass 75 to 80 percent of the agency's 
discretionary grants and believe they will improve the efficiency of 
the grant award process. In addition, SAMHSA officials told us that 
while most new award decisions have been made at the end of the fiscal 
year, they expect that this consolidation will allow the agency to 
issue some awards earlier in the year.[Footnote 32]

SAMHSA's Performance Management System Does Not Sufficiently Recognize 
Differences in Employee Achievement:

SAMHSA has adopted a new performance management system for its 
employees[Footnote 33] that is intended to hold staff accountable for 
results by aligning individual performance expectations with the 
agency's goals--a practice that we have identified as key for effective 
performance management.[Footnote 34] SAMHSA is aligning the performance 
expectations of its administrator and senior executives with the 
agency's long-term goals and priority issues and then linking those 
expectations with expectations for staff at lower levels. As a result, 
SAMHSA's senior executives' performance expectations are linked 
directly to the administrator's objectives, and all other employees 
have at least one performance objective that can be linked to the 
administrator's objectives. For example, objectives related to 
implementing the four new discretionary grant announcements are 
included in the 2003 performance plans of the appropriate center 
directors, branch chiefs, and project officers.

In contrast, other aspects of SAMHSA's performance management system do 
not reinforce individual accountability for results. SAMHSA's 
performance management system does not make meaningful distinctions 
between acceptable and outstanding performance--an important practice 
in a results-oriented performance management system.[Footnote 35] 
Instead, staff ratings are limited to two categories, "meets or exceeds 
expectations" or "unacceptable." SAMHSA managers told us that few staff 
receive an unacceptable rating and that using a pass/fail system can 
make it difficult to hold staff accountable for their performance. 
Moreover, this type of system may not give employees useful feedback to 
help them improve their performance, and it does not recognize 
employees who are performing at higher levels.

In addition, SAMHSA's performance management system does not assess 
staff performance in relation to specific competencies. Competencies 
define the skills and supporting behaviors that individuals are 
expected to exhibit in carrying out their work, and they can provide a 
fuller picture of an individual's contributions to achieving the 
agency's goals. SAMHSA's strategic workforce plan includes a 
description of the competencies that staff need, including technical 
competencies related to data collection and analysis, co-occurring 
disorders, and service delivery.[Footnote 36] However, these 
competencies have not been incorporated into the agency's performance 
management system to help reinforce behaviors and actions that support 
the agency's goals.

SAMHSA Is Taking Action to Improve Its Partnerships with Federal 
Agencies and Departments:

SAMHSA jointly funds grant programs with other federal agencies and 
departments, often through agreements that enable funds to be 
transferred between agencies. While these interagency agreements can 
streamline the grant-making process, SAMHSA's lengthy procedures for 
approving them have delayed the awarding of grants. SAMHSA officials 
told us that they recently implemented policies to expedite the 
approval process. In addition to jointly funding programs, SAMHSA 
shares mental health and substance abuse expertise and information with 
other federal agencies and departments. Grantees with whom we spoke 
identified opportunities for SAMHSA to better coordinate with its 
federal partners to disseminate information about effective practices 
to states and community-based organizations.

SAMHSA Is Taking Steps to Expedite Approval of Joint Funding 
Arrangements:

SAMHSA frequently collaborates with other federal agencies and 
departments to jointly fund grant programs that support a range of 
substance abuse and mental health services. (See table 3 for examples 
of jointly funded programs.) For example, for the $34.4 million 
Collaborative Initiative to Help End Chronic Homelessness, SAMHSA, the 
Health Resources and Services Administration, the Department of Housing 
and Urban Development, and the Department of Veterans Affairs provide 
funds or other resources related to their own programs and the 
populations they generally serve. SAMHSA's funds are directed toward 
the provision of substance abuse and mental health services for 
homeless people.

Table 3: Selected Collaborative Initiatives between SAMHSA and Its 
Federal Partners:

Grant program: Safe Schools, Healthy Students Initiative; 
Federal partner(s): Department of Education, Department of Justice; 
SAMHSA funding (fiscal year 2003): $71.0 million; 
Purpose: To implement and enhance comprehensive communitywide 
strategies for creating safe and drug-free schools and promoting 
healthy childhood development.

Grant program: Serious and Violent Offenders Re-entry Initiative; 
Federal partner(s): Department of Education, Department of Housing and 
Urban Development, Department of Justice, Department of Labor; 
SAMHSA funding (fiscal year 2003): $8.0 million; 
Purpose: To prepare offenders to successfully return to their 
communities after having served a significant period of confinement.

Grant program: Collaborative Initiative to Help End Chronic 
Homelessness; 
Federal partner(s): Health Resources and Services Administration, 
Department of Housing and Urban Development, Department of Veterans 
Affairs; 
SAMHSA funding (fiscal year 2003): $7.4 million; 
Purpose: To end chronic homelessness by seeking to create a 
collaborative and comprehensive approach to addressing homelessness.

Grant program: Science to Service: State Implementation of Evidence-
based Programs; 
Federal partner(s): National Institutes of Health; 
SAMHSA funding (fiscal year 2003): $2.8 million; 
Purpose: To promote and support implementation of evidence-based 
mental health treatment practices in state systems.

Grant program: Collaboration to Link Health Care for the Homeless 
Programs and Community Mental Health Agencies; 
Federal partner(s): Health Resources and Services Administration; 
SAMHSA funding (fiscal year 2003): $1.2 million; 
Purpose: To develop partnerships between community mental health and 
homeless health care systems.

Source: GAO analysis of HHS and Departments of Education, Housing and 
Urban Development, and Justice documents.

[End of table]

Many of SAMHSA's joint funding arrangements use interagency agreements 
to transfer funds between agencies,[Footnote 37] which allow grantees 
to receive all of their grant funds from a single federal agency or 
department (see table 4). For example, Safe Schools, Healthy Students 
grantees receive all of their funds from the Department of Education, 
even though SAMHSA also supports this program. SAMHSA officials told us 
that interagency transfers create fewer funding streams and make the 
process less confusing to grantees.[Footnote 38]

Table 4: Fiscal Year 2003 Interagency Agreements between SAMHSA and 
Its Federal Partners:

Center: Center for Mental Health Services; 
Funds transferred from the center: Number of agreements: 24; 
Funds transferred from the center: Funds: $80,536,775; 
Funds transferred to the center: Number of agreements: 24; 
Funds transferred to the center: Funds: $87,096,930.

Center: Center for Substance Abuse Prevention; 
Funds transferred from the center: Number of agreements: 19; 
Funds transferred from the center: Funds: $1,839,787; 
Funds transferred to the center: Number of agreements: 9; 
Funds transferred to the center: Funds: $7,445,505.

Center: Center for Substance Abuse Treatment; 
Funds transferred from the center: Number of agreements: 10; 
Funds transferred from the center: Funds: $8,482,000; 
Funds transferred to the center: Number of agreements: 3; 
Funds transferred to the center: Funds: $2,140,000.

Center: Total; 
Funds transferred from the center: Number of agreements: 53; 
Funds transferred from the center: Funds: $90,858,562; 
Funds transferred to the center: Number of agreements: 36; 
Funds transferred to the center: Funds: $96,682,435. 

Source: GAO analysis of SAMHSA documents.

[End of table]

While transferring funds can streamline the grant process, SAMHSA's 
system for approving interagency agreements has been inefficient. 
Before the funds are transferred, the agencies involved must approve an 
interagency agreement describing the amount of money being transferred 
and how it will be used. Officials from the Departments of Justice and 
Education told us that SAMHSA's approval process was lengthy and 
resulted in agreements being completed at the last minute. The 
Department of Education found that it took SAMHSA more than 70 days to 
approve the 2003 Safe Schools, Healthy Students interagency agreement-
-a period that SAMHSA estimated was about 40 days longer than in 
previous years. SAMHSA officials told us that the approval process was 
complicated by the lack of a clear policy identifying the SAMHSA 
management officials who needed to review and approve the agreements. 
In March 2004, SAMHSA implemented new policies that clarify the process 
for reviewing and approving agreements and the responsibilities of 
specific SAMHSA officials. At that time, SAMHSA also began to track the 
time it takes for the agency to review and approve interagency 
agreements. It is too early to know how SAMHSA's new policies will 
affect the efficiency of the approval process.

SAMHSA Has Efforts Under Way to Better Coordinate with Other Agencies 
to Share Information on Effective Practices:

SAMHSA provides its expertise and information on substance abuse and 
mental health to other federal agencies and departments and 
collaborates with them to share information with states and community-
based organizations. For example, officials from the Health Resources 
and Services Administration told us that in coordinating health care 
and mental health services for people who are homeless, they use 
SAMHSA's knowledge of community-based substance abuse and mental health 
providers who can work with primary care providers. Also, the Office of 
National Drug Control Policy uses data from SAMHSA's National Survey on 
Drug Use and Health to determine the extent to which it has achieved 
its goals and objectives. This survey also provides data to support 
HHS's Healthy People 2010's substance abuse focus area.[Footnote 39]

Several grantees told us that SAMHSA and the National Institutes of 
Health could better collaborate to ensure that providers have 
information about the most effective ways to deliver substance abuse 
and mental health services. Recognizing the importance of such a 
partnership, the two agencies recently initiated the Science to Service 
initiative, which is designed to better integrate the National 
Institutes of Health's research on effective practices with the 
services funded by SAMHSA.[Footnote 40] For example, in fiscal year 
2003, SAMHSA and the National Institutes of Health funded a grant to 
help states more readily integrate effective mental health practices 
into service delivery in their states.[Footnote 41]

In addition, grantees recommended that SAMHSA better coordinate with 
the Departments of Education and Justice to disseminate information 
about effective practices to states and community-based organizations. 
For example, a state official told us that SAMHSA and the Department of 
Education do not ensure that their processes for evaluating substance 
abuse prevention programs result in comparable sets of model 
programs.[Footnote 42] The two agencies evaluate programs using 
different criteria and rate some prevention programs differently. 
SAMHSA reported that it may be appropriate for agencies to have 
different criteria because each agency must have the ability to tailor 
its criteria to meet the specific goals of its grant programs. A SAMHSA 
official acknowledged, however, that SAMHSA and the Departments of 
Education and Justice are discussing how they can refine their criteria 
for evaluating prevention programs and better communicate the results 
to grantees.

SAMHSA Could More Effectively Manage Partnerships with State and Local 
Grantees:

Officials from state mental health and substance abuse agencies and 
community-based organizations identified opportunities for SAMHSA to 
better manage its block and discretionary grant programs. They cited 
concerns with SAMHSA's grant application processes, site visits, and 
the availability of information on technical assistance. SAMHSA plans 
to transform its block grants into performance partnership grants in 
fiscal years 2005 and 2006, and the agency, along with the states, is 
preparing for the change. However, state officials are concerned that 
SAMHSA has not finalized the performance data that states would report 
under the proposed performance partnership grants. In addition, SAMHSA 
has not completed the plan it must send to the Congress identifying the 
data reporting requirements for the states and any legislative changes 
needed to implement the performance partnership grants.

Grantees Have Raised Concerns about SAMHSA's Grant Processes:

Officials from states and community-based organizations[Footnote 43] 
told us that SAMHSA could improve administration of its grant programs, 
citing concerns related to the agency's grant application review 
processes, site visits to review states' compliance with block grant 
requirements, and the availability of information on technical 
assistance opportunities. In some instances, SAMHSA has begun to 
respond to these issues.

Discretionary Grant Applications:

Grantees we talked to expressed concern that SAMHSA rejects 
discretionary grant applications without reviewing them for merit if 
they do not comply with administrative requirements.[Footnote 44] 
SAMHSA told us that of the 2,054 fiscal year 2003 applications it 
received after January 3, 2003, 393--19 percent--were rejected in this 
initial screening process.[Footnote 45] Of the 14 grantees we 
interviewed, 4 told us that SAMHSA rejected 1 of their 2003 grant 
applications without review and a fifth had 5 applications rejected. 
Grantees told us that this practice does not enable applicants to 
obtain substantive feedback on the content of their applications. They 
also said that SAMHSA's practice of waiting to notify applicants of the 
rejection until it notifies all applicants of funding decisions--near 
the start of the next fiscal year--impedes their fiscal planning.

In response to concerns over the number of grant applications it 
rejected on administrative grounds in fiscal year 2003, SAMHSA has 
changed the way it will screen fiscal year 2004 applications. On March 
4, 2004, SAMHSA announced revised requirements that are intended to 
simplify and expedite the initial screening process for discretionary 
grants.[Footnote 46] For example, SAMHSA will no longer automatically 
screen out applicants because their application is missing a section, 
such as the table of contents. Instead, the agency will consider 
whether the application contains sufficient information for reviewers 
to consider the application's merit. In addition, SAMHSA will allow 
applicants more flexibility in the format of their application. Instead 
of focusing exclusively on specific margin sizes or page limits, SAMHSA 
will consider the total amount of space used by the applicant to 
complete the narrative portion of the application.[Footnote 47] SAMHSA 
expects that under the new procedures it will screen out significantly 
fewer applications. However, some applications continue to be rejected 
for administrative reasons and will not receive a merit 
review.[Footnote 48] In another change, a SAMHSA official told us that 
it would begin to notify applicants within 30 days of the decision if 
their application is rejected.[Footnote 49]

Block Grant Applications:

State officials told us that the length and complexity of the mental 
health and substance abuse block grant applications create difficulties 
for both states and project officers. They described the block grant 
applications as confusing, repetitive, and difficult to complete. 
Furthermore, officials in five states told us that SAMHSA project 
officers may not be using the information states provide in the block 
grant application as well as they could, especially the narrative 
portion. For example, one state official received questions from the 
project officer about the state's substance abuse activities for women 
and children that could have been answered by reading the narrative 
section of the application. State officials suggested that project 
officers could more easily use the information states provided if the 
application were streamlined and included only the information most 
important to SAMHSA. They suggested that SAMHSA make these changes when 
it converts the block grants to performance partnership grants. SAMHSA 
officials told us they will not know whether the applications can be 
streamlined until they finalize the format of the performance 
partnership grants.

To allow center staff to retrieve information more quickly from the 
current substance abuse block grant application, the Center for 
Substance Abuse Prevention and the Center for Substance Abuse Treatment 
began to use a Web-based application in spring 2003. The Web-based 
application allows the centers to retrieve information collected from 
the substance abuse block grant applications and more quickly develop 
reports analyzing data across states, such as the number of states in 
compliance with specific block grant requirements.[Footnote 50]

Site Visits:

State officials told us that SAMHSA's site visits to review states' 
compliance with block grant requirements do not always allow the agency 
to adequately review their programs. For example, officials in three 
states told us that the length of these visits--often 3 to 5 days--is 
too short for SAMHSA to fully understand conditions in the state that 
affect the provision of services. Officials in two of these states said 
3-day site visits did not provide reviewers with enough time to visit 
mental health care providers in the more remote parts of the state and 
observe how they respond to local service delivery challenges. A SAMHSA 
official told us that 3-day site visits are generally adequate for most 
states, but states are able to request a longer visit. The official 
acknowledged that SAMHSA could better communicate this flexibility to 
states.

Technical Assistance:

Officials from eight states said the technical assistance they received 
from SAMHSA and its contractors[Footnote 51] was helpful;[Footnote 52] 
officials from five states told us that the agency could improve its 
dissemination of information about what assistance is available to 
grantees. For example, one state official suggested that SAMHSA provide 
more information on its Web site about what assistance is available or 
has been requested by other states. He said that making this 
information available is especially important because there is high 
staff turnover at the state level, and relatively new staff may have 
little knowledge about what SAMHSA offers. Several state mental health 
officials commented that SAMHSA's substance abuse block grant has a 
more structured technical assistance program than the mental health 
block grant and is able to offer more assistance opportunities. SAMHSA 
officials noted that the substance abuse block grant program has more 
funds and staff to devote to the provision of technical assistance. 
SAMHSA's Center for Substance Abuse Treatment, for example, has a 
separate program branch to manage technical assistance contracts. This 
center is in the process of creating a list of documents that grantees 
developed with the help of technical assistance contractors--such as a 
state strategic plan for providing substance abuse services--so that 
other states can use them as models.

SAMHSA Is Preparing States for Performance Partnership Grants, but Has 
Not Finalized States' Reporting Requirements:

To prepare for the mental health and substance abuse performance 
partnership grants--which SAMHSA plans to implement in fiscal years 
2005 and 2006, respectively--SAMHSA has worked with states to develop 
performance measures and improve states' ability to report performance 
data. Specifically, SAMHSA identified outcomes for which states would 
be required to report performance data.[Footnote 53] SAMHSA asked 
states to voluntarily report on performance measures related to these 
outcomes in their fiscal year 2004 block grant applications and the 
agency provided states with funding to help them make needed changes to 
their data collection and reporting systems. Over fiscal years 2001 and 
2002, SAMHSA awarded 3-year discretionary grants of about $100,000 per 
year to state mental health and substance abuse agencies to develop 
systems for collecting and reporting performance data.[Footnote 54] 
State officials told us they used the grants in a variety of ways, such 
as to train service providers to report performance data.

Substance abuse and mental health agency officials we talked to told us 
that their states have made progress in preparing to report on 
performance measures, but that their states would need to make 
additional data system changes before they could report all of the data 
that SAMHSA has proposed for the performance partnership grants. For 
example, officials from three states told us that they were still 
unprepared to report data that would come from other state agencies--
such as information on school attendance obtained from the state's 
education system. In addition, several state officials told us they 
have been unable to complete their preparations because they are 
waiting for SAMHSA to finalize the data it will require states to 
report. For example, a state mental health director told us that the 
lack of final reporting requirements has contributed to a delay in the 
implementation of the state's new information management system. 
Similarly, officials from a state substance abuse agency told us that 
without SAMHSA's final requirements, the state agency is limited in its 
ability to require substance abuse treatment providers to change the 
way they report performance data.

In addition, the Congress may need to make statutory changes before 
SAMHSA can implement the performance partnership grants, but SAMHSA has 
not given the Congress the information it sought on what changes are 
needed or on how the agency proposes to implement the grants--including 
the final data reporting requirements for the states. In 2000, the 
Congress directed SAMHSA to submit a plan containing this information 
by October 2002. SAMHSA submitted this plan to HHS for internal review 
on April 12, 2004, after which the plan must receive clearance from the 
Office of Management and Budget. SAMHSA could not tell us when it 
expects to submit the plan to the Congress.

Conclusions:

SAMHSA's leaders are taking steps to improve the management of the 
agency, but key planning tools are not fully in place. SAMHSA has been 
slow to issue a strategic plan, which is essential to guide the 
agency's efforts to increase program accountability and direct 
resources toward accomplishing its goals. Furthermore, while SAMHSA is 
in the process of implementing its strategic workforce plan, the 
agency's workforce planning efforts lack important elements--such as a 
detailed succession strategy--to help SAMHSA prepare for future 
workforce needs. Because future retirements and attrition could leave 
the agency without the appropriate workforce to effectively carry out 
its programs, it would be prudent for SAMHSA to have a succession 
strategy to help it retain institutional knowledge, expertise, and 
leadership continuity.

In addition, SAMHSA has not completed plans to ensure that its 
workforce has the appropriate expertise to manage the proposed 
performance partnership grants, which would represent a significant 
change in the way SAMHSA holds states accountable for achieving 
results. These grants would require new skills from SAMHSA's workforce. 
Therefore, it is important for SAMHSA to complete hiring and training 
strategies to ensure that its workforce can effectively implement the 
grants.

SAMHSA cannot convert the block grants to performance partnership 
grants until it gives the Congress its implementation plan, which was 
due in October 2002. The Congress needs the information in SAMHSA's 
plan for its deliberations about legislative changes that may be needed 
to allow SAMHSA to implement the performance partnership grants. In 
addition, the plan's information on the performance measures SAMHSA 
will use to hold states accountable is needed by the states as they 
prepare to report required performance data. If SAMHSA does not 
promptly submit this plan, states may not be ready to submit all needed 
data by the time SAMHSA has planned to implement the grants--in fiscal 
years 2005 and 2006--and SAMHSA may not have the legislative authority 
needed to make the mental health and substance abuse prevention and 
treatment block grant programs more accountable and flexible.

Finally, as SAMHSA makes efforts to increase program accountability, it 
is in the agency's interest to fund state and local programs that show 
the most promise for improving the quality and availability of 
prevention and treatment services. Although SAMHSA has made changes 
that should reduce the number of discretionary grant applications 
rejected solely for administrative reasons--such as exceeding the 
specified page limitation--some applications are still not reviewed for 
merit because of administrative errors. Allowing applicants to correct 
such errors and resubmit their application within an established time 
frame could help ensure that reviewers are able to assess the merits of 
the widest possible pool of applications and could increase the 
likelihood of SAMHSA's funding the most effective mental health and 
substance abuse programs.

Recommendations for Executive Action:

We recommend that, to improve SAMHSA's management of its programs, 
promote the effective use of its resources, and increase program 
accountability, the Administrator of SAMHSA take the following four 
actions:

* Develop a detailed succession strategy to ensure SAMHSA has the 
appropriate workforce to carry out the agency's mission.

* 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.

* 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.

* 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 Comments:

We provided a draft of this report to SAMHSA for comment. Overall, 
SAMHSA generally agreed with the findings of the report. (SAMHSA's 
comments are reprinted in app. III.) SAMHSA said that it already has 
efforts under way to address each of the report's key findings and 
recommendations, and that it endorses the value the report places on 
strategic planning, workforce planning, and collaboration with federal, 
state, and community partners.

SAMHSA indicated that it will continue to engage in a strategic 
planning process and said that its priority issues and principles are 
central to this process. As we had noted in the draft report, SAMHSA 
commented that it expects to complete and approve the action plans 
developed by each of its priority issue work groups by June 30, 2004. 
SAMHSA also said that it would update its draft strategic plan to 
include summaries of the action plans, and then disseminate the draft 
for public comment, submit it to HHS for clearance, and publish the 
final plan. Our draft report stated that SAMHSA did not want to issue 
its strategic plan before HHS issued the new departmental strategic 
plan. In its comments, SAMHSA noted that HHS published its strategic 
plan in April 2004 and that this was no longer an issue affecting 
SAMHSA's schedule for publishing its plan.

In its comments, SAMHSA also stated that it places a high priority on 
the development of a succession plan. SAMHSA said that it is preparing 
for an anticipated increase in the agency's attrition rate over the 
next several years and is reviewing the pool of staff eligible to 
retire to identify the skills and expertise that could be lost to the 
organization. While SAMHSA is beginning to engage in succession 
planning, it has not developed a detailed succession strategy. We have 
made our recommendation more specific to communicate the need for 
SAMHSA to develop such a strategy.

In response to our recommendation that SAMHSA complete hiring and 
training strategies to ensure that the agency's workforce has the 
appropriate expertise to implement performance partnership grants, 
SAMHSA said that it is addressing the need for its workforce to have 
the appropriate expertise. For example, SAMHSA indicated that it has 
initiated efforts to identify training needed by current staff and to 
ensure that new staff have needed skills. However, we believe it is 
important for SAMHSA to fully develop both hiring and training 
strategies to ensure that it has the appropriate workforce in place 
when it implements performance partnership grants.

In response to our recommendation to develop a procedure to allow 
applicants to correct administrative errors in discretionary grant 
applications, SAMHSA commented that its new screening procedures have 
yielded a substantial increase in the percentage of applications that 
will be reviewed for merit. As a result, SAMHSA believes our 
recommendation is premature and said that it plans to evaluate the 
results of the revised procedures before making any additional changes. 
While early evidence indicates that the new procedures are reducing the 
proportion of applications rejected for administrative reasons, these 
procedures have not eliminated such rejections. Because it is important 
for reviewers to be able to assess the merits of the widest possible 
pool of applications, we believe it would be beneficial for SAMHSA to 
develop the procedure we are recommending without delay.

Finally, in response to the report's discussion of the performance 
partnership grants, SAMHSA commented that it will continue its efforts 
to increase accountability in its block grant and discretionary grant 
programs. SAMHSA said that the proposed fiscal year 2005 mental health 
and substance abuse block grant applications contain outcome measures 
that the agency expects to use to monitor grant performance. However, 
these applications have not been finalized, and the draft applications 
indicate that several of the performance measures are still being 
developed. It is important for SAMHSA to give the Congress its plan for 
implementing the performance partnership grants so that the Congress 
can consider any legislative changes that might be necessary to 
implement the grants and SAMHSA can more fully hold states accountable 
for achieving specific results.

SAMHSA also provided technical comments. We revised our report to 
reflect SAMHSA's comments where appropriate.

As arranged with your office, unless you publicly announce its contents 
earlier, we plan no further distribution of this report until 30 days 
after its issue date. We are sending copies of this report to the 
Secretary of Health and Human Services, the Administrator of SAMHSA, 
appropriate congressional committees, and other interested parties. We 
will also make copies available to others who are interested upon 
request. In addition, the report will be available at no charge on the 
GAO Web site at http://www.gao.gov.

If you or your staff have any questions, please contact me at (312) 
220-7600 or Helene Toiv, Assistant Director, at (202) 512-7162. Janina 
Austin, William Hadley, and Krister Friday also made major 
contributions to this report.

Sincerely yours,

Signed by: 

Leslie G. Aronovitz: 
Director, Health Care--Program Administration and Integrity Issues:

[End of section]

Appendix I: Scope and Methodology:

In performing our work, we obtained documents and interviewed officials 
from the Substance Abuse and Mental Health Services Administration 
(SAMHSA). While we reviewed documents related to SAMHSA's strategic 
planning and to its performance management system, we did not perform a 
comprehensive evaluation of SAMHSA's management practices. We also 
reviewed the policies and procedures the agency uses to oversee states' 
and other grantees' use of block and discretionary grant funds. We 
interviewed officials from SAMHSA's Office of the Administrator; Office 
of Policy, Planning, and Budget; Office of Program Services; Office of 
Applied Studies; Center for Mental Health Services; Center for 
Substance Abuse Prevention; and Center for Substance Abuse Treatment.

To determine how SAMHSA collaborates with other federal agencies and 
departments, we interviewed officials from the Department of Education, 
the Department of Justice, and the Department of Health and Human 
Services' Centers for Disease Control and Prevention, Health Resources 
and Services Administration, and National Institutes of Health. After 
reviewing lists of collaborative efforts provided by SAMHSA's centers, 
we selected these agencies because each one is involved in a 
collaborative effort with each of SAMHSA's three centers. Within these 
agencies, we identified collaborative initiatives that involve 
interagency committees, data sharing, interagency agreements, and other 
joint funding arrangements. We interviewed and obtained documentation 
related to these initiatives from federal agency officials who were 
directly involved in them. We also interviewed officials from the 
Centers for Medicare & Medicaid Services because Medicaid is the 
largest public payer of mental health services and officials from the 
Indian Health Service, which provides substance abuse and mental health 
services to tribal communities. We interviewed officials from the White 
House Office of National Drug Control Policy, which coordinates federal 
antidrug efforts.

To determine how SAMHSA collaborates with state grantees, we 
interviewed officials from state mental health and substance abuse 
agencies. We interviewed mental health agency officials in California, 
Colorado, Connecticut, Mississippi, and South Dakota, and substance 
abuse agency officials in Iowa, Massachusetts, Montana, Texas, and 
Virginia. We selected these states on the basis of variation in their 
geographic location, the size of their fiscal year 2003 mental health 
or substance abuse block grant award, the number of discretionary grant 
awards they received in fiscal year 2002,[Footnote 55] and their 
involvement in SAMHSA initiatives to improve states' ability to report 
mental health and substance abuse data.

To gain a better understanding of SAMHSA's collaborative efforts, we 
interviewed officials from community-based organizations that received 
discretionary grants from each of SAMHSA's centers. We selected the 
largest discretionary grant programs available to community-based 
organizations from the Center for Substance Abuse Treatment (the 
Targeted Capacity Expansion: HIV Program) and the Center for Mental 
Health Services (the Child Traumatic Stress Initiative). We selected 
the Center for Substance Abuse Prevention's Best Practices: Community-
Initiated Prevention Intervention Studies--the center's second largest 
discretionary grant program available to community-based 
organizations--to provide a variety of SAMHSA's priority 
issues.[Footnote 56] We also selected one grant that was jointly funded 
by SAMHSA and the Health Resources and Services Administration (the 
Collaboration to Link Health Care for the Homeless Programs and 
Community Mental Health Agencies). (See table 5.) For each of the four 
grant programs, we selected one community-based organization that 
received grant funds in fiscal year 2001 or 2002 and that was located 
in 1 of the 10 states we selected.

Table 5: Information on Selected Discretionary Grant Programs:

Grant: Targeted Capacity Expansion: HIV; 
Sponsoring center: Center for Substance Abuse Treatment; 
Priority issue: HIV/AIDS and hepatitis; 
Funding (fiscal year 2003): $61.5 million.

Grant: Child Traumatic Stress Initiative; 
Sponsoring center: Center for Mental Health Services; 
Priority issue: Children and families; 
Funding (fiscal year 2003): $29.8 million.

Grant: Best Practices: Community-Initiated Prevention Intervention 
Studies; 
Sponsoring center: Center for Substance Abuse Prevention; 
Priority issue: Strategic prevention framework; 
Funding (fiscal year 2003): $9.8 million.

Grant: Collaboration to Link Health Care for the Homeless Programs and 
Community Mental Health Agencies; 
Sponsoring center: Center for Mental Health Services; 
Priority issue: Homelessness; 
Funding (fiscal year 2003): $1.2 million.

Source: GAO analysis of SAMHSA documents.

[End of table]

To obtain additional information about SAMHSA's collaboration with 
state agencies and other grantees, we interviewed representatives of 
the National Association of State Alcohol and Drug Abuse Directors, the 
National Association of State Mental Health Program Directors, and the 
Community Anti-Drug Coalitions of America. These organizations 
represent, respectively, state substance abuse agencies, state mental 
health agencies, and community-based substance abuse prevention 
organizations. We also interviewed representatives of the National 
Alliance for the Mentally Ill and the National Council on Alcoholism 
and Drug Dependence, because those organizations represent consumers of 
mental health services and substance abuse services, respectively. We 
conducted our work from July 2003 through May 2004 in accordance with 
generally accepted government auditing standards.

[End of section]

Appendix II: SAMHSA's Strategic Workforce Plan Goals and Strategies, by 
Focus Area:

Goals; 
Focus areas: Clarifying organizational purpose: SAMHSA has a strong 
leadership and management capacity, a clearly defined role as a 
national leader in substance abuse and mental health services, and a 
well-structured organization to support its mission; 
Focus areas: Creating effective work processes: SAMHSA has effective 
and efficient processes and methods for accomplishing its mission and 
optimizing its workforce; 
Focus areas: Valuing our most critical asset--people: SAMHSA 
strategically invests in its workforce by putting the right people in 
the right place at the right time. SAMHSA systematically recruits, 
selects, and hires talented employees and continuously re-recruits 
them by creating a great place to work and by developing the 
competencies needed to achieve its mission.

Strategies; 
Focus areas: Clarifying organizational purpose: Ensure that SAMHSA has 
a cross-functional executive leadership team that works together to 
guide the organization toward achieving its mission; 
Develop a clear and compelling multiyear strategy that is dynamic, 
aligned with the organizational mission, and linked to the performance 
of each organizational component and employee; 
Create an organizational structure that maintains the strengths of the 
current system, focuses on quality, and increases flexibility and 
capacity; 
Focus areas: Creating effective work processes: Improve the 
development, review, and management of discretionary grants; 
Improve the publication clearance process; 
Examine the block and formula grants process to create a more 
efficient and streamlined process; 
Establish a new system for responding to external requests; 
Continue to enhance customer-focused and effective infrastructure at 
SAMHSA; 
Focus areas: Valuing our most critical asset--people: Change the size, 
scope, and distribution of the workforce of SAMHSA; 
Anticipate competency needs and strategically close competency gaps 
where needed; 
Continue to enhance a systematic approach to recruiting skilled talent 
in a tight labor market; 
Continue to enhance a systematic approach to retaining existing 
expertise; 
Enhance the design and implementation of a systematic approach to 
developing the workforce; 
Develop a systematic performance management system to align individual 
effort with strategic imperatives; 
Implement a technology tool to provide SAMHSA with workforce profile 
data for managing its workforce. 

Source: GAO analysis of SAMHSA's Strategic Workforce Plan 2001-2005.

[End of table]

[End of section]

Appendix III: Comments from the Department of Health and Human 
Services:

DEPARTMENT OF HEALTH & HUMAN SERVICES: 
Substance Abuse and Mental Health Services Administration:
Center for Mental Health Services: 
Center for Substance Abuse Prevention:
Center for Substance Abuse Treatment:
Rockville MD 20857:

MAY 14 2004:

Ms. Leslie G. Aronovitz: 
Director, Health Care - Program Administration and Integrity Issues: 
General Accounting Office: 
Washington, D.C. 20548:

Dear Ms. Aronovitz:

Thank you for the opportunity to provide comments on your draft report 
entitled SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION: 
Planning for Program Changes and Future Workforce Needs is Incomplete 
(GAO-04-683).

Overall, we accept the findings of the report. Each of its key findings 
and recommendations focuses on an area already identified by the 
Substance Abuse and Mental Health Services Administration (SAMHSA) as 
needing further action or improvement, and I am pleased to say that 
efforts are already well underway to address each of these issues. We 
fully endorse the value the report places on strategic planning, 
workforce planning, and collaboration with our Federal, State, and 
community partners. Our comments below are designed to clarify some of 
SAMHSA's accomplishments in these areas.

Strategic Planning:

SAMHSA will continue its active engagement in an ongoing and dynamic 
strategic planning process. Our matrix of priorities and cross-cutting 
principles is central to this process. The mission, vision, goals, and 
objectives resulting from the strategic planning process were contained 
in our fiscal year (FY) 2004 and FY 2005 budget submissions, and are 
forming the basis for full integration of budget and performance in our 
FY 2006 budget submission. Our FY 2004 and FY 2005 budget requests were 
organized by strategic goal and matrix priority area. SAMHSA has 
approved action plans for some of the matrix priority areas, to guide 
program development. The remainder are to be completed and approved by 
June 30. Once the action plans are completed, the draft SAMHSA 
strategic plan will be updated, and summaries of the action plans will 
be appended. The plan will then be disseminated for public comment, 
submitted to the Department of Health and Human Services (DHHS) for 
clearance, and published. As the DHHS strategic plan was sent to 
Congress in early April and is now publicly available, the timing of 
its publication no longer affects the schedule for SAMHSA's strategic 
plan.

Workforce Planning:

The report recommends that SAMHSA "implement workforce succession 
planning," and indicates SAMHSA is not developing a succession plan. To 
the contrary, SAMHSA has already begun to address this issue, and we 
place a high priority on our development of a succession plan. In FY 
2005, 25 percent of SAMHSA staff will be eligible for voluntary 
retirement. Despite a moderate attrition rate of 10 percent in FY 2003, 
SAMHSA is making preparations for an anticipated increase in this rate 
over the coming years. We are reviewing the pool of staff eligible to 
retire within the next several years to identify skills and expertise 
that could be lost to the organization. These competencies will be 
integrated, as appropriate, into the curriculum of our ongoing 
management development program. When staff in key positions notify us 
of anticipated retirement, we immediately begin recruitment planning. 
Staff capabilities and training needs are assessed on an ongoing basis 
to guide recruitment plans, and to re-tool our current workforce. 
SAMHSA aggressively recruits outstanding scholars and other highly 
qualified job candidates, to offset the anticipated retirement trends. 
Such recruitment is frequently conducted nationwide.

The report recommends that SAMHSA "ensure the agency's workforce has 
the appropriate expertise to implement the performance partnership 
grants." We have already taken several steps to address this need. 
SAMHSA has identified a number of areas in which the project officers 
require further professional development to adequately address their 
future responsibilities. Current project officers are being reassigned 
to updated position descriptions that reflect the new responsibilities, 
and their performance will be assessed on those responsibilities. 
Recruitment for new project officers uses the updated position 
descriptions, and job candidates are assessed against the new skill set 
requirements. A workgroup has been convened to develop prioritized, 
individual staff development plans, and to identify and schedule 
necessary training for affected staff.

Discretionary grant applications:

The report recommends that SAMHSA "develop a procedure to allow 
applicants for discretionary grants to correct administrative errors in 
applications and resubmit them." In FY 2004, SAMHSA improved its 
procedures to ensure applications are subjected to peer review whenever 
possible. Criteria that exclude applications from review are only those 
necessary to ensure a fair and competent review, and are similar to the 
requirements of other Federal agencies. The criteria include: 
programmatic eligibility criteria (such as appropriate licensure); 
compliance with application deadlines; legibility; and adherence to 
space limitations to ensure an equal playing field. The new procedures 
have yielded a substantial increase in the percentage of applications 
submitted to peer review. Given the recent implementation of these 
improvements, we view the report's recommendation to be premature. 
SAMHSA plans to evaluate the success of the changes in FY 2004 before 
determining whether additional changes are needed and what they would 
be.

Performance Partnership Grants:

The report recommends that SAMHSA "expedite completion of the plan for 
the Congress providing information on the performance partnership 
grants." SAMHSA will continue on its path to increase accountability in 
its block grant and discretionary programs. We have identified seven 
domains of client outcomes, in which we anticipate data would be 
collected to monitor grant performance. These outcome measures have 
been publicized in the proposed FY 2005 applications for both the 
mental health and substance abuse block grants, and in the Requests for 
Applications for both the Access to Recovery program and the Strategic 
Prevention Framework State Incentive Grants. By unifying data 
collection efforts in these seven domains, we anticipate reducing 
multiple reporting burden on the States and other grantees, and 
aggregating data across programs to assess performance. We look forward 
to submitting the Report to Congress, and to implementing the changes 
necessary to ensure the highest quality of services are provided 
through this critical funding source.

Thank you again for the chance to provide clarification on these 
issues. If you have any further questions, please feel free to contact 
me on 301-443-4795.

Sincerely,

Signed by: 

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

[End of section]

FOOTNOTES

[1] U.S. Department of Health and Human Services, Mental Health: A 
Report of the Surgeon General (Rockville, Md.: 1999).

[2] Substance Abuse and Mental Health Services Administration, Results 
from the 2002 National Survey on Drug Use and Health: National Findings 
(Rockville, Md.: 2003).

[3] Substance Abuse and Mental Health Services Administration, Report 
to Congress on the Prevention and Treatment of Co-Occurring Substance 
Abuse Disorders and Mental Disorders (Rockville, Md.: 2002).

[4] Unless otherwise noted, in this report, "states" refers to the 50 
states, the territories, and the District of Columbia.

[5] SAMHSA awards block grants to all states and territories and the 
District of Columbia; awards are allocated according to statutory 
formulas that take into account specific characteristics of each state, 
such as population size and the cost of providing services. 

[6] Pub. L. No. 106-310, § 3403, 114 Stat. 1101, 1219 (codified at 42 
U.S.C. § 300x-59 (2000)).

[7] Pub. L. No. 102-321, 106 Stat. 324 (codified at 42 U.S.C. § 290aa 
et seq. (2000)).

[8] The National Survey on Drug Use and Health was formerly called the 
National Household Survey on Drug Abuse.

[9] The U.S. Public Health Service Commissioned Corps is one of the 
seven Uniformed Services of the United States. The Commissioned Corps 
provides a variety of services to help promote the health of the 
nation, such as delivering health care services to medically 
underserved populations and providing health expertise during national 
emergencies. 

[10] SAMHSA's program management budget covers the salaries of 486 of 
the agency's 504 full-time-equivalent employees. The salaries of the 
remaining 48 employees are funded by portions of the substance abuse 
and mental health block grants retained by SAMHSA for administrative 
purposes.

[11] Five percent of the substance abuse and mental health block grants 
is retained at SAMHSA; in fiscal year 2003, this amounted to almost 
$110 million, of which SAMHSA used 47 percent for the collection of 
national substance abuse data, 39 percent for technical assistance 
activities, 12 percent for state data systems, and 2 percent for 
program evaluation. 

[12] States with an AIDS case rate of greater than 10 per 100,000 
population are currently required to spend 2 percent to 5 percent of 
their substance abuse block grant allocation on HIV/AIDS-related 
substance abuse programs. The specific percentage is related to the 
change in the state's block grant allocation since 1990, and, in 
practice, all states affected by the requirement are now required to 
spend 5 percent. 42 U.S.C. § 300x-24(b)(2), 4(A) and (B) (2000).

[13] 42 U.S.C. § 300x-59 (2000).

[14] The initial review group consists of mental health and substance 
abuse experts, primarily from outside the federal government, and 
people who have received substance abuse or mental health services.

[15] SAMHSA and the individual centers each have an advisory council 
composed of professionals from relevant scientific and health fields 
and individuals representing the interests of the public. The councils 
were established by the Congress to advise, consult with, and make 
recommendations to SAMHSA on substance abuse and mental health issues. 
The national advisory councils do not review applications for grants 
that are required by the Congress or are less than $100,000.

[16] The Division of Grants Management is within SAMHSA's Office of 
Program Services.

[17] Under the Single Audit Act, nonfederal entities that expend 
$300,000 ($500,000 for fiscal years ending after December 31, 2003) are 
required to obtain an independent audit of all federal awards. The 
audit includes a review of internal controls, compliance with laws and 
regulations, and costs charged to federal programs. 31 U.S.C. § 
7502(a)(1)(A), (3), and (e)(1) - (4) (2000).

[18] 42 U.S.C. § 300x-55(g)(1) (2000).

[19] The Public Health Service Act requires states to maintain state 
expenditures for community mental health services and drug abuse 
treatment at a level that is not less than the average level of state 
expenditures for the previous 2 years. 42 U.S.C. §§ 300x-4(b)(1) and 
300x-30(a) (2000).

[20] Prior to the 1992 legislation that created SAMHSA, HHS's Alcohol, 
Drug Abuse, and Mental Health Administration was responsible for major 
federal substance abuse and mental health activities related to both 
services and research. In the 1992 legislation, the Congress 
transferred research responsibilities to the National Institutes of 
Health, to be carried out by the National Institute on Alcohol Abuse 
and Alcoholism, National Institute on Drug Abuse, and National 
Institute of Mental Health. 

[21] SAMHSA also has partnerships with the Department of Defense, 
Department of Homeland Security, Department of Labor, Department of 
Transportation, Nuclear Regulatory Commission, Small Business 
Administration, Social Security Administration, and Corporation for 
National and Community Service. 

[22] SAMHSA's previous strategic plan covered the period from May 1996 
through fiscal year 2002. 

[23] Promoting accountability involves measuring and reporting program 
performance; enhancing capacity involves increasing the availability of 
substance abuse and mental health services. 

[24] SAMHSA officials told us that the priorities are evolving, and the 
agency is not precluded from focusing on other emerging areas. 

[25] The Government Performance and Results Act requires federal 
agencies' strategic plans to include six components: (1) a 
comprehensive agency mission statement; (2) agencywide long-term goals 
and objectives for all major functions and operations; (3) approaches 
(or strategies) to achieve the goals and objectives and the various 
resources needed; (4) the relationship between the long-term goals/
objectives and the annual performance goals; (5) an identification of 
key factors, external to the agency and beyond its control, that could 
significantly affect achievement of the strategic goals; and (6) a 
description of how program evaluations were used to establish or revise 
strategic goals and a schedule for future program evaluations. 5 U.S.C. 
§ 306(a) (2000). HHS is required to comply with the Government 
Performance and Results Act, and it is good practice for its component 
agencies to follow the same guidelines in developing their strategic 
plans.

[26] In addition to developing strategies to address long-term staffing 
needs and determine the critical skills and competencies needed to 
carry out programs, other important principles of strategic workforce 
planning are building the capacity to implement the strategies; 
monitoring and evaluating the agency's progress toward achieving its 
workforce goals; and involving top management, employees, and other 
stakeholders in developing, communicating, and implementing the 
strategic workforce plan. For additional information on these 
principles, see U.S. General Accounting Office, Human Capital: Key 
Principles for Effective Workforce Planning, GAO-04-39 (Washington, 
D.C.: Dec. 11, 2003).

[27] See U.S. General Accounting Office, Human Capital: Insights for 
U.S. Agencies from Other Countries' Succession Planning and Management 
Initiatives, GAO-03-914 (Washington, D.C.: Sept. 15, 2003).

[28] To help create effective work processes, SAMHSA's strategic 
workforce plan called for the development of a team to streamline the 
process for administering the block grants. As a result, SAMHSA 
established a block grant reengineering team to examine the processes, 
policies, and procedures that govern the administration of the 
Substance Abuse Prevention and Treatment Block Grant. The team 
presented its final report to SAMHSA's administrator on September 26, 
2003.

[29] SAMHSA has indicated that the training will be either provided or 
arranged for by the fall of 2005. 

[30] For additional information on key components of strategic 
workforce training and development efforts, see U.S. General Accounting 
Office, Human Capital: A Guide for Assessing Strategic Training and 
Development Efforts in the Federal Government, GAO-04-546G (Washington, 
D.C.: March 2004).

[31] The announcements describe the general design of the four types of 
grants and provide application instructions. The four types of grants 
are: (1) services grants to implement evidence-based approaches, (2) 
infrastructure grants to support activities such as coordinating 
funding streams and developing performance measures, (3) best practices 
planning and implementation grants to help communities test and 
evaluate best practices for providing services, and (4) service-to-
science grants to document and evaluate innovative practices.

[32] In fiscal year 2003, 76 percent of SAMHSA's new grants were 
awarded in the fourth quarter, with 65 percent awarded in September, 
the last month of the fiscal year. A SAMHSA official told us that 
grants receiving second and third year funding are usually made earlier 
in the fiscal year.

[33] Performance management is a system for setting expectations for 
employees and evaluating their performance. 

[34] Other key practices are (1) connecting performance expectations to 
crosscutting goals; (2) providing and routinely using performance 
information to track organizational goals; (3) requiring follow-up 
actions, based on performance information, to address organizational 
priorities; (4) using competencies to provide a fuller assessment of 
performance; (5) linking pay to individual and organizational 
performance; (6) making meaningful distinctions in performance; (7) 
involving employees and stakeholders to gain ownership of performance 
management systems; and (8) maintaining continuity during transitions. 
See U.S. General Accounting Office, Results Oriented Cultures: Creating 
a Clear Linkage between Individual Performance and Organizational 
Success, GAO-03-488 (Washington, D.C.: Mar. 14, 2003). 

[35] See GAO-03-488. 

[36] In addition to technical competencies, SAMHSA also identified 
leadership, management, interpersonal and organizational, and human 
resource competencies. 

[37] Interagency agreements allow an agency to enter into an 
arrangement in which it pays another agency for goods and services it 
receives or is paid by another agency for goods and services it 
provides. 31 U.S.C. § 1535 (2000).

[38] In contrast, the Collaborative Initiative to Help End Chronic 
Homelessness, in which SAMHSA participates with three other federal 
agencies, does not use interagency agreements, and grantees had to 
complete four separate applications and receive their grant funds from 
each agency. The President's fiscal year 2004 and 2005 budgets proposed 
a similar grant program involving these four agencies--the Samaritan 
Initiative--that would use interagency transfers of funds, but the 
Congress has not authorized this initiative.

[39] HHS's Healthy People 2010 is a set of disease prevention and 
health promotion objectives. These objectives are arranged into 28 
focus areas, including 1 on substance abuse and 1 on mental health and 
mental disorders. Using its National Survey on Drug Use and Health, 
SAMHSA is responsible for reporting baseline data and data measuring 
progress toward the 2010 targets.

[40] The Science to Service initiative is a collaboration among 
SAMHSA's three centers and the National Institutes of Health's National 
Institute of Mental Health, National Institute on Alcohol Abuse and 
Alcoholism, and National Institute on Drug Abuse.

[41] SAMHSA also coordinates with the National Institutes of Health to 
disseminate effective substance abuse treatment practices identified by 
National Institutes of Health researchers through SAMHSA's 14 regional 
addiction technology transfer centers.

[42] SAMHSA's National Registry of Effective Programs and Practices 
provides a list of programs that have met SAMHSA's criteria for 
effectiveness and are ready to be disseminated as model programs. The 
Department of Education's Safe and Drug-Free Schools program also has a 
list of best practices, some of which are part of SAMHSA's National 
Registry of Effective Programs and Practices.

[43] We interviewed officials from five state mental health agencies, 
five state substance abuse agencies, and four community-based 
organizations.

[44] In fiscal year 2003, SAMHSA rejected applications without review 
if the applications did not meet specific format requirements, such as 
font or margin specifications or page limitations; were received after 
the due date; did not contain required documentation; did not respond 
to the grant's guidelines and review criteria; or had excessive funding 
requests.

[45] SAMHSA officials told us that of the 1,661 applications that were 
reviewed for merit, 300 were awarded grants. SAMHSA was unable to 
provide data on the number of applications rejected without review for 
fiscal year 2003 applications received through January 3, 2003, or for 
applications received in previous years. 

[46] 69 Fed. Reg. 10,254 (Mar. 4, 2004).

[47] SAMHSA will require that the total area of the project narrative 
(excluding margins, but including charts, tables, graphs, and 
footnotes) not exceed 58.5 square inches--the total area available on 
the page--multiplied by the page limit reported in the grant 
announcement.

[48] A SAMHSA official told us that as of April 29, 2004, SAMHSA had 
screened 100 fiscal year 2004 applications and rejected 11 for 
administrative reasons.

[49] HHS released a grant application manual--HHS Awarding Agency 
Grants Administration Manual--on October 1, 2003; section 2.04.104C-8 
requires SAMHSA and other HHS agencies to notify applicants within 30 
days if their grant application has been rejected.

[50] The Center for Mental Health Services does not use a Web-based 
application, but it has created tables that enable states to enter 
performance data for the mental health block grant online.

[51] SAMHSA may contract with a mental health or substance abuse expert 
to provide technical assistance targeted to a state's specific needs.

[52] In addition, officials from one state told us that the technical 
assistance they received from SAMHSA did not meet their needs and an 
official from a second state told us that he had not requested or 
received any technical assistance from SAMHSA within the past year.

[53] SAMHSA officials told us that they are working with the states to 
measure and report on the following outcomes: (1) abstinence from 
alcohol abuse or drug use and decreased symptoms of mental illness, (2) 
increased or retained employment and school enrollment, (3) decreased 
involvement with the criminal justice system, (4) increased stability 
in family and living conditions, (5) increased access to services, (6) 
increased retention in substance abuse treatment and reduced 
utilization of psychiatric inpatient beds, (7) increased social 
supports and social connectedness, (8) client perception of care, (9) 
cost effectiveness, and (10) use of evidence-based practices. The 
outcomes will also be the basis for performance data that SAMHSA 
requires for other grants it awards to states.

[54] The Center for Mental Health Services awarded grants of about 
$100,000 to mental health agencies in 49 states and the District of 
Columbia; Ohio and Micronesia did not receive funds and the other 
territories received $50,000 each. The Center for Substance Abuse 
Treatment awarded $100,000 grants to the substance abuse agencies in 32 
states, the District of Columbia, and Puerto Rico; the U.S. Virgin 
Islands received $50,000.

[55] Fiscal year 2002 was the most recent year for which this 
information was available.

[56] The Center for Substance Abuse Prevention's largest discretionary 
grant program is the Targeted Capacity Expansion: Substance Abuse 
Prevention and HIV Prevention in Minority Communities Initiative, 
which, like the Targeted Capacity Expansion: HIV Program, falls within 
SAMHSA's HIV/AIDS and hepatitis priority issue.

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