Presented by:John. J. Campbell, M.A.John M. Morrow, Ph.D.

Optimizing Federal Funding Streams to Support COD Services

Financing Integrated Service Programs for Persons with

Co-Occurring Disorders

John J. Campbell, MAActing Director, Center for Substance Abuse Treatment, Division of State and Community

Assistance

Co-Occurring Disorders

Substance Abuse Prevention and Treatment Block Grant (SAPTBG)

Purposes• “…planning, carrying out, and evaluating activities to

prevent and treat substance abuse and for related activities authorized in section 1924.”

• Section 1921(b) of Title XIX, Part B, Subpart II of the PHS Act (42 U.S.C. 300x-21(b)) Authorized Activities

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SAPTBG Funds Utilization

Services Covered • SAPTBG funds are designated for substance abuse

prevention and treatment services statute and regulations• Title XIX, Part B, Subpart II and Subpart III of the Public

Health Service Act (42 U.S.C. §§ 300x-21-66) as amended by P.L. 102-321 and P.L. 106-310)

• Substance Abuse Prevention and Treatment Block Grant; Interim Final Rule (45 C.F.R. §§ 96.120-137)

 

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SAPTBG and other CSAT Funding

FY 2010 AppropriationThe FY 2010 SAPT Block Grant is

$1,798,591,000 which represents and increase of $20,000,000 (1.12 percent) relative to the FY 2009 appropriation of $1,778,591,000.

• Consolidated Appropriations Act, 2010 (P.L. 111-117)• http://www.samhsa.gov/Budget/FY2010/index.aspx

• Discretionary Portfolio total: $143,575,000

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Co-Occurring Disorders

Description of the Problem/Issue• Co-occurring substance-related and mental disorders

(individual-level and service level are distinct) • Some evidence supports an increased prevalence of

people with COD• Rates of mental disorders increase as the number of

substance use disorders increases, further complicating treatment

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Co-Occurring Disorders

Description of the Problem/Issue (con.)Compared to people with mental or substance use disorders alone,

people with COD are more likely to have:• More frequent hospital visits • Increased severity, disability, and impairment in

social/occupational functioning• Increased resistance to traditional pharmacologic treatment• Increased suicidality• Increased economic burden of each co-morbid condition• Lower probability of recovery

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Co-Occurring Disorder Strategies

Long Term Goals• Increase the percentage of persons with CODs who

receive appropriate treatment services that address both disorders

• Increase the percentage of adolescents aged 12 – 17 who receive appropriate prevention services that address CODs

• Increase the percentage of persons who experience reduced impairment from their CODs following appropriate treatment

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Co-Occurring Disorder Strategies

Measurable Objectives• Increase the percentage of prevention and treatment

settings that: o screen for CODs o assess for CODs o provide treatment to clients through collaborative,

consultative and integrated models of care

• Increase the number of grantees (States, communities, and providers) measuring and reporting on co-occurring programs and practices and models of treatment

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Co-Occurring Disorder Strategies

Measurable Objectives (con.)• Increase the number of people trained to implement

appropriate co-occurring prevention and integrated treatments among States, communities, providers and consumers

• Increase the number of States and Tribes with State and Tribal-level action plans for improving access to mainstream and specialty services for individuals with CODs

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Four Quadrant Typology (TIP 42)

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IIILess severe mental

disorder/more severesubstance abuse

disorder

ILess severe mentaldisorder/less severe

substance abusedisorder

IIMore severe mentaldisorder/less severe

substance abusedisorder

Hig

h Se

verit

yH

igh

Seve

rity

Low SeverityLow Severity High SeverityHigh Severity

Alco

hol a

nd o

ther

dru

g ab

use

Alco

hol a

nd o

ther

dru

g ab

use

Mental IllnessMental Illness

IVMore severe mental

disorder/more severesubstance abuse

disorder

SAMHSA’s COD Position Statement(February 1999)

• Conceptual Framework - 3 levels of service coordination: consultation, collaboration, or integration.

• Developed by state substance abuse and mental health directors.

• Definitional reliance on severity of functional impairment as depicted by the 4 quadrant typology published in TIP 42.

SAMHSA’s COD Position Statement(February 1999)

• Consultative Approach – based upon informal provider relationships: Quad I

• Collaborative Approach – based upon more formal provider relationships: Quad II & III

• Integrated Treatment – Single Treatment Plan and Team: Quad IV

• A caveat: recent trends in policy and practice suggest that more, not less integrated treatment will be the norm.

SAMHSA’s COD Position Statement(February 1999)

“…specifically the Substance Abuse Prevention and Treatment Block Grant (SAPTBG) funds and Community Mental Health Services Block Grant (CMHSBG) funds may be used to provide services for people with co-occurring disorders as long as those funds are used for the purposes for which they are authorized by law and can be appropriately tracked for accounting purposes.”

Substance Abuse Services Funding

Substance Abuse State Agency Spending Report (FY 2010):

SAPT Block Grant 33%

Medicaid 13%

Other Federal Funds 5%

State Funds 46%

Local Funds 1%

Other Funds 2%

Tracking Block Grant Funds

Tracking funds for COD servicesWhen states have SAPTBG and MHBG, they should:• Develop systems to track funding of services by grant

o Broken down by substance abuse (SAPTBG) and mental health (MHBG) services

o Systematic and quantifiableo Coded correctly

• While this may be easier when services are provided separately, there are ways to account for more integrated service provision

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Optimizing Federal Funding: Discussion Questions: Does your State use MHBG and SAPT block grant dollars to finance COD services? How?

Has your State experienced any barriers to using block grant dollars to finance COD services? What were those barriers?

What recommendations or suggestions do you have for SAMHSA to help address these barriers?

What recommendations or suggestions do you have for other States that may encounter these barriers?