Center for Mental Health Services
Children's Mental Health Services Program

(Dollars in thousands)

Authorizing Legislation - Section 565 of the PHS Act

2005 Authorization Expired

Purpose and Method of Operation

The Children's' Mental Health Services Program, first authorized in 1992, primarily supports SAMHSA's Capacity goal. The program supports the development of comprehensive community-based systems of care for children and adolescents with serious emotional disorders and their families. An estimated 21% of children in the United States have a diagnosable mental or addictive disorder, yet two-thirds are not expected to receive mental health services. The program also provides strong support to SAMHSA's Effectiveness goal through the implementation of best practices, and its strong evaluation component supports the Accountability goal. The program directly supports the Children's Agenda priority area.

Program funds are available through competitive cooperative agreements to States, political subdivisions of States, Territories, and Indian Tribes or tribal organizations. Funds are used to build on the existing service infrastructure so that the array of services required to meet the needs of the target population is available and accessible. Grants are limited to a total of 6 years, with an increasing non-Federal matching requirement over the term of the award. The matching requirement is intended to promote sustainability of the local systems of care beyond the grant period. It is estimated that over 18 of the first 22 grant communities initially funded in fiscal years 1993 and 1994 have continued to be sustained as service delivery systems since the federal program funds ended in fiscal years 1999 and 2000.

From 1993-2003, CMHS has funded 92 grants in 46 States, and provided services to approximately 54,343 children. The program has served children in 274 or 9% of the 3,142 counties in the United States, representing a small proportion of the country being exposed to these highly successful system-of-care services. Given the demonstrated services need and the positive outcomes in funded sites, continued support of this program is a clear priority.

Accomplishments

CMHS-funded communities:

• Have made an impact on local and State policy reform
  
• Apply system-of-care principles to a greater extent than non-funded communities
  
• Improve the functional and clinical outcomes of children and their families
  
• Increase involvement of families and youth
  
• Better understand how culture influences care for children and their families

The Children's Mental Health Program has invested consistently in program evaluation. Outcomes from the evaluation have been used to monitor program performance. Cumulative results document a solid record of positive outcomes, maintained over the life of the program to date.

In addition, results through 2002 from the 23 grant cohort funded in 1997 and 1998 show that:


• The rate of school suspensions declined dramatically from 41.4% at intake, to 35.9% at six months, to 30.4% at 12 months, and to 28.7% at 18 months.
  
• The percentage of children with a "D" grade average or below declined from 43.7% at intake to 32.2% at 18 months.
  
• The rate of arrests decreased from 12% at intake, to 9.3% at six months, to 7.4% at 12 months, and to 6.5% at 18 months.
  
• 92.5% of the children improved or remained stable in their problem behaviors and emotions after six months.

Funding levels for the past five fiscal years were as follows:

Funding FTEs

2000.... $82,763,000 -
2001.... 91,645,000 -
2002.... 96,631,000 -
2003.... 98,053,000 -
2004.... 102,353,000 -

Rationale for the Budget Request
The FY 2005 budget proposes $106 million, an increase of approximately $4 million over the final FY 2004 conference level. This amount will support the continuation of 30 grants and the award of 24 new grants. Funding also will continue support for evaluation, technical assistance, and communication activities.

The Children's Mental Health Services Program was one of the SAMHSA programs selected for review with the OMB Program Assessment Rating Tool (PART) reported in the FY 2004 budget. The program scored well and was considered "Moderately Effective". As a component of this assessment, SAMHSA established, with DHHS and OMB, several long-term measures for the program that will be used to track and improve performance:

• By FY 2010, 60 percent of grantees will exceed a 30 percent improvement in behavioral and emotional symptoms among children receiving services.
  

• By FY 2010, 80 percent of systems of care will continue to be sustained at least throughout the first five years after Federal funding has ended.
  

• By FY 2010, 30% of grantees will decrease inpatient care costs by 10%.

Rating: Moderately Effective

Program Type: Competitive Grants

Program Summary:

The Children's Mental Health Services program makes competitive grants to state and local governments to support services for children with serious emotional disturbance.

The assessment found:

1. The Children's Mental Health Services program is making a unique contribution to improve care for children with serious emotional disturbance, but reaches a limited number of communities and the national impact is not fully known.

2. The program purpose is clear and commonly held by interested parties.

3. The program supports an annual evaluation to demonstrate improvements in services and outcomes for children with serious emotional disturbance in funded communities.

4. While accountability for results could be improved, the program uses performance information to improve annual outcomes.

5. The program has limited data related to the newly adopted long-term performance measures, but is meeting most of the annual targets.

6. A recent evaluation indicates the program is effective at improving the care and well being of children with serious emotional disturbance. After two years of services, 42 percent of the children showed a significant reduction in severe behavioral and emotional problems and an additional 48 percent of the children were stabilized.

Based on these findings, the Administration:

1. Proposes an increase of $10 million above the 2003 Budget to extend the reach of the program and help additional communities provide effective services to children with serious emotional disturbance.

2. Will determine if the program is making lasting improvements in the care of children with serious emotional disturbance. The program will track how well children's behavioral and emotional symptoms improve and how well funded communities sustain their systems of care beyond the period of federal funding.

PART Corrective Action Plan