Substance Abuse and Mental Health Services Administration

**40th Meeting of the SAMHSA National Advisory Council**

**Minutes**

**Thursday, June 29, 2006**

## 

The Substance Abuse and Mental Health Services Administration (SAMHSA)
National Advisory Council convened for its 40th meeting on June 29,
2006, at SAMHSA headquarters in Rockville, Maryland. Charles G. Curie,
M.A., A.C.S.W., Administrator, SAMHSA, chaired the meeting.

Council Members Present: Council Co-Chair James R. Aiona, Jr. (by
telephone), Faye Annette Gary, Ed.D., R.N., Diane Holder, Barbara Huff,
Thomas A. Kirk, Jr., Ph.D., Theresa Racicot, Kenneth D. Stark and
Kathleen Sullivan

Council Members Absent: Columba Bush and Gwynneth A. E. Dieter.

Ex-Officio Member Present: Laurent S. Lehmann, M.D.

Council Executive Director: Daryl W. Kade, M.A.

Council Executive Secretary: Toian Vaughn, M.S.W.

SAMHSA Staff Present: Kathryn A. Power (Director, Center for Mental
Health Services), Dennis Romero (Acting Director, Center for Substance
Abuse Prevention), and H. Westley Clark (Director, Center for Substance
Abuse Treatment).

Non-SAMHSA Federal Staff Present: 3 individuals (see Tab B for Federal
Attendees List).

Representatives of the Public Present: 22 individuals (see Tab B for
Public Attendees List).

THURSDAY, JUNE 29, 2006

**Welcome and Opening Remarks**

SAMHSA Administrator Charles G. Curie called the Council meeting to
order at 9:20 a.m. and welcomed attendees. He announced the resignation
of Thomas Lewis from the Council due to health and family concerns and
acknowledged his role in advocating for individuals with mental illness
and addictive disorders as well as his dedicated service to the Council.
Ms. Columba Bush and Mrs. Gwynneth Dieter were not able to attend due to
scheduling conflicts. Mr. Curie remarked that the Council orientation
session, that was held a day earlier, offered opportunities for insight
into SAMHSA programs and helped to introduce the leadership team. New
additions to SAMHSA's leadership team include Acting Deputy
Administrator Dr. Eric B. Broderick,

Dr. Larke Huang (the new "children's czar"), and SAMHSA Senior Advisor
to the Administrator, Mr. Arne Owens, whose duties include veterans
issues and community- and

faith-based initiatives within SAMHSA, and the offices of HHS and the
White House.

Mr. Curie acknowledged the presence of Dr. Westley Clark, Director,
Center for Substance Abuse Treatment (CSAT), Mr. Dennis Romero, Acting
Director, Center for Substance Abuse Prevention (CSAP) and Mr. Ted
Searle, Deputy Director, Center for Mental Health Services (CMHS)
representing CMHS Director Ms. Kathryn Power.

**Administrator's Report**

Mr. Curie announced that he has submitted his resignation as SAMHSA
Administrator to the President, effective August 5, 2006, and
acknowledged that he was inspired by the participation of Council
members and SAMHSA's constituency groups, their passion, value system,
and assuring that people find their voice. He stated that the mission of
building resilience and facilitating recovery remains unrealized until
outcomes in people's lives include finding their own voices and making
lives in the community.

Mr. Curie reviewed SAMHSA's agenda of priorities and highlighted
selected achievements at SAMHSA during his stewardship:

-   Alignment and leveraging of resources around priorities, using the
    SAMHSA Matrix;

-   Influential Centers within SAMHSA, to which people look for
    direction and resources, and the Office of Applied Studies, which
    helps inform the field;

-   Focus on consumer- and family-driven systems, synthesizing diverse
    input to enable wise investment of resources consistent with
    Administration goals as set forth by the SAMHSA Council and
    constituency groups;

-   Increased accountability to investors, the Congress, the White
    House, HHS, and constituency groups;

-   Focus on resilience and recovery and on operationalizing recovery
    from public policy and public finance standpoints;

-   Leveraging systemic changes in Centers' initiatives resulting in
    increased engagement of community- and faith-based providers in
    Access to Recovery (ATR) and the New Freedom Initiative (NFI);

-   Implementation of the data strategy through the creation of National
    Outcome Measures and State Outcome Measures and Management Systems;

-   Increased focus on reducing time lags in the science-to-service
    agenda;

-   Development of a platform to inform the field through the National
    Registry of Evidence‑Based Programs and Practices (NRREP) for both
    prevention and treatment;

-   CMHS's development of the National Consensus Statement on Mental
    Health Recovery;

-   CMHS's leadership in convening more than 20 Federal agencies to
    develop the Federal Action Agenda for Mental Health System
    Transformation and State Incentive Grants for Mental Health
    Transformation;

-   Implementing (ATR) infrastructure change, which empowers States and
    tribal organizations to offer an increased and broader choice of
    services;

-   Implementation of the 2002 Co-occurring Report to Congress,
    recognizing that treatment of people with co-occurring mental
    illness and addiction disorders should be the expectation, and
    sustainable treatment must address both;

-   Increased efforts to bring prevention to scale on a national level,
    including the incorporation of SAMHSA's Strategic Prevention
    Framework (SPF) into the Federal Helping America's Youth Initiative;
    implementation of SPF in 40 States;

-   The dissemination of tools such as Communities That Care, provides
    science-based decisions to States to assess protective factors and
    provide implementation strategies;

-   Empowering local communities with information and resources in
    recognition of their abilities to best solve local substance abuse
    problems;

-   Reduction in illicit drug use among youth by 19 percent since 2002
    is a tribute to stakeholders who operate with a more unified
    approach;

-   Increased focus on workforce development recognizing its critical
    connection to service quality improvement;

-   Continued efforts on suicide prevention, the reduction and
    elimination of coercion, seclusion and restraint practices, and
    underage drinking; and,

-   Developing mental health and substance abuse modules in disaster
    plans in collaboration with States.

Mr. Curie urged SAMHSA to continue international work in promoting
recovery and working with post‑conflict developing countries. He
reiterated his belief that mental health and substance abuse are central
to public health and urged Council members to continue serving as
SAMHSA's ambassadors.

**Council Discussion**

Council members unanimously thanked Mr. Curie for his leadership
contributions. Mr. Kenneth Stark thanked Mr. Curie for his strong
leadership with SAMHSA and observed that his long-standing legacy will
be the use of the NOMS and the ability to measure States' outcomes and
provide consistency across State and Federal entities. He suggested that
SAMHSA encourage the three research institutes at the National
Institutes of Health (National Institute of Mental Health, National
Institute on Drug Abuse, and National Institute on Alcohol Abuse and
Alcoholism) to collaborate with States and use them as laboratories for
service research.

Ms. Kathleen Sullivan thanked Mr. Curie for respecting and honoring
consumers. Ms. Barbara Huff expressed her appreciation that Mr. Curie
has included advocates on the Council to provide input. She expressed
her hope that future administrators will continue to include on the
Council advocates who are family members.

Dr. Faye Gary observed that the new focus on workforce development will
shape how all other priorities on the Matrix will be addressed. She
urged SAMHSA and other research institutes to investigate poverty as a
risk factor for mental illness and substance abuse, and to consider
early interventions. She also urged thinking about a "cure" for mental
illness and adding the word to SAMHSA's vocabulary.

Mr. "Duke" Aiona observed that to make a difference in communities,
people must engage in dialogue and collaboration, and weather the
inevitable conflicts and challenges that accompany change. He also
emphasized the importance of SPF in outcome measurement. Mr. Curie
thanked Mr. Aiello for his service as Council co-chair and noted the
importance of elected officials advocating for prevention and treatment.

Dr. Thomas Kirk asserted that Mr. Curie's greatest legacy is the vision
and agenda of change that he set for SAMHSA around substance abuse and
mental health issues, and for his work in forging partnerships to
promote recovery and creating hope and empowerment for people with
mental illnesses and substance abuse disorders---thus creating a natural
advocacy.

Dr. Laurent Lehman stated that the President's New Freedom Commission on
Mental Health helped to move the Department of Veterans Affairs (VA)
toward recovery and rehabilitation. He acknowledged SAMHSA's lead in a
conference for community and state mental health leaders on how to deal
with disasters post September 11, 2001 and in the March 2006 conference
on returning veterans.

Mr. Curie acknowledged SAMHSA's work in that field and further noted the
Agency's efforts post September 11 in working with States to develop a
mental health and substance abuse consequence module to add to their
disaster plans.

**Consideration of the Minutes from the December 6-7, 2005, Council
Meeting**

The minutes of the December 6-7, 2005 Council meeting were approved
unanimously as submitted.

**Leadership to Keep Children Alcohol Free Initiative**

Ms. Michele Ridge, Leadership Foundation member and former First Lady of
Pennsylvania, explained that the Leadership to Keep Children Alcohol
Free Initiative (Initiative) relies on establishing a social capital
that promotes networking and relationships building to meet its goals.
In 1999, NIAAA and the Robert Wood Johnson Foundation invited the
spouses of State Governors to join a coalition of Federal agencies and
public and private organizations to prevent the use of alcohol by
children ages 9 to 15. In March 2000, the Initiative was launched and
approximately 20 governors' spouses took the pledge to ensure that the
prevention of early alcohol use by children is recognized as a priority
concern for the nation and to educate the public about the dangers posed
by such early use.

Ms. Ridge noted that the science behind the Initiative gives the
governors' spouses the credibility to recruit their respective State
agencies, advocacy groups, parent groups, and others to address underage
drinking. The Initiative has sponsored conferences and regional
meetings, developed a website (alcoholfreechildren.org), enlisted
partners, and worked with the health care field and scientific advisory
groups. Ms. Ridge indicated that the success of the Initiative is
reflected in the non-partisan approach by the States on this issue. The
group's work has leveraged action by others and put a public face on the
matter of childhood drinking. Ms. Ridge offered statistics from the
Centers for Disease Control and Prevention's (CDC) 2005 Youth Risk
Behavior Surveillance survey revealing that 71 percent of Americans age
10-24 die from car crashes, injuries, homicide, and suicide, with
alcohol involved in more than 40 percent of the incidents; and, of
children who drink regularly under age 14, 40 percent will have alcohol
addiction issues to deal with as adults.

Ms. Theresa Racicot, SAMHSA National Advisory Council member, former
First Lady of Montana, and Leadership to Keep Children Alcohol-Free
Foundation president, noted that, in addition to its current 40 sitting
members, the Initiative now includes 18 emeritus spouses who are very
involved and committed to the issue. The sitting spouses have advocated
for the Surgeon General's Call to Action, worked on SAMHSA's town hall
meetings, supported the Institute of Medicine's recommendations, and
maintained strong relationships with a broad spectrum of organizations.
Important focuses include consideration of the cost of childhood
drinking related to law enforcement and justice, and potential for a
program of primary care screening. With Federal funding expiring in
2007, the Initiative formed the bipartisan Leadership Foundation to
develop continuing funding sources.

**Council Discussion**

Ms. Diane Holder noted the importance of confronting the idyllic
national misperception that children are protected through education and
the enlistment of cooperating pediatricians. In response to Ms. Holder's
question, Ms. Ridge noted that engagement of schools varies by State and
typically is driven by parent organizations. Ms. Racicot added that each
spouse sets a unique agenda and acknowledged Columba Bush's leadership
as co-chair of the Initiative.

Ms. Huff likened the Initiative with one undertaken by congressional
spouses who advocated successfully for Systems of Care for children's
mental health and permitted the issue to rise to the surface and for
legislation to pass.

Mr. Stark asked whether the initiative has been involved in model
legislation to promote prevention activities and reduce access. Ms.
Ridge noted that some States have passed key registration legislation,
but activity levels vary by State. Ms. Racicot noted that high school
students lobbied successfully for key registration in Wyoming.

Dr. Gary observed the usefulness of other groups as members of the
network, including the juvenile justice system, school systems,
faith-based organizations, and others. Ms. Ridge responded that in
individual States, most governors' spouses have brought community groups
together, to which the Initiative provides considerable evidence-based
programming materials and technical assistance.

To another question from Dr. Gary, Ms. Racicot responded that there is
no scientifically-based evaluation process, however, one measure of the
Initiative's success can be evaluated by the amount of materials
requested and disseminated to 40 countries and nationally around town
hall meetings. Mr. Aiona echoed concern about sustainability and
attributed Hawaii's aggressive campaign to the motivation and support of
the Initiative.

**SAMHSA's International Activities**

Mr. Curie stated that SAMHSA's mission focuses primarily on domestic
issues, with no funds appropriated for international programs.
Nevertheless, exposure to international issues has promoted learning
from other countries, and the United States (U.S.) has provided
technical assistance as countries develop their substance abuse and
mental health services delivery system. A current focus is rebuilding
the mental health services infrastructure in post-conflict Iraq and
Afghanistan. Mr. Curie described the approach of the Iraqis as one that
integrates mental health with primary health care, which is a direction
that is gaining momentum within the United States. Afghanistan has set
up a challenging 10-point plan that mirrors the work-in-progress in
Iraq. Mr. Curie further acknowledged the unique stressors affecting the
Iraqi mental health team where they are the target for insurgency and
kidnapping.

Ms. Winnifred Mitchell-Frable, International Officer, SAMHSA, explained
that this round of health diplomacy focuses on the common ground of
improving mental and behavioral health and addressing service needs. In
its international work, SAMHSA collaborates with the United Nations
Office on Drugs and Crime in Central America. Additionally, SAMHSA is
working to reestablish its efforts in Russia on substance abuse
prevention and primary care screening as an HIV detection tool. SAMHSA
staff also work in Vietnam and in Geneva on World Health Organization
(WHO) mental health matters.

A planning group for Iraq includes staff from SAMHSA, National Institute
of Mental Health (NIMH), National Institute on Drug Abuse (NIDA), the
HHS Office on Global Health, the Departments of Defense and State, as
well as Iraqi mental health advisors and colleagues in the United
Kingdom. The group conducts biweekly conference calls for technical
assistance and as a mentoring device. An action planning conference in
Jordan in 2005 led to recommendations to institute a referral system
which was institutionalized in 3 provinces, and to develop a code of
practice for mental health. In 2006, at the Cairo conference, rival
factions worked together to develop recommendations that built upon the
work started in Amman. Ms. Mitchell-Frable noted that the effort is
carried by Iraqi expatriates, Iraqis and other diplomats, and the WHO.
She added that SAMHSA is recognizing and plans to support emerging
leaders by providing them with training opportunities.

SAMHSA also established a workgroup for Afghanistan's mental health
system. In Kabul in May 2006, people who work in mental health around
the country, non-governmental agencies, and other funding partners
convened for the first time. They developed a series of lessons learned,
including the need for ongoing support and supervision in addition to
short-term training; the challenge of finding and retaining staff;
recognizing the vulnerable status of women and children; and the
universal experience of violence and trauma. Challenges include defining
standards for interventions, determining how to screen and provide
substance abuse services, and limited public awareness of substance
abuse and mental health problems. The group recommended building human
capacity, integrating behavioral health into primary care, and
increasing public awareness. Next steps in Afghanistan and Iraq are to
provide targeted support for implementation of national strategic plans
and support for training and emerging leaders. Ms. Mitchell-Frable
emphasized that, in Afghanistan, there is hope and the opportunity to
integrate mental health into primary care. WHO and other nongovernmental
organizations will participate in the effort, and cultural competence
will be an important skill.

**Council Discussion**

Ms. Mitchell-Frable responded to a question from Ms. Huff that consumer
advocacy organizations participate in both Iraq and Afghanistan. To a
question from Ms. Sullivan, Ms. Mitchell-Frable and Mr. Curie
acknowledged that Iraqi health workers face significant risks.

**SAMHSA's Access to Recovery Program: Update**

Mr. Curie stated that during the first three-year cycle, the
presidential initiative Access to Recovery (ATR) is implemented in 14
States and 1 tribal organization. Congress and others in the field have
expressed interest in ATR's outcomes, and data appears highly
encouraging in terms of more people receiving access to treatment, care,
recovery, and recovery support services. Nevertheless, ATR's future
remains in question.

CSAT Director, H. Westley Clark, explained that the voucher-based ATR
program focuses on recovery and emphasizes consumer choice,
accountability, and effectiveness. ATR aims to address the treatment gap
and expand access to care by ensuring a client's choice for clinical
treatment and recovery support services at the appropriate level of
care. Dr. Clark stated that ATR provides for a significant level of
outreach to a wide range of service providers that have not previously
received funding, such as community- and faith-based organizations, thus
expanding opportunities for care. He emphasized that community support
is inextricably linked to recovery, and noted that holistic support may
contribute cumulatively to a person's recovery.

Dr. Clark reviewed ATR's status through March 2006 and indicated that:
(1) all grantees had uploaded data; (2) more than 62,000 clients were
served (26 percent more than projected); (3) more than 56 percent of
clients for whom status and discharge data are available have received
recovery support services; (4) 43 percent of the value of redeemed
vouchers was redeemed for recovery support services; (5) outcome
measures on abstinence, employment, social connectedness, criminal
justice involvement, and stable housing by discharged were positive; (6)
faith-based organizations redeemed about 30 percent of the ATR expended
dollars for clinical and recovery support services, or about \$48
million; and (7) faith-based organizations accounted for approximately
21 percent of all recovery support service providers and 33 percent of
clinical treatment providers that redeemed vouchers.

Dr. Clark summarized the activities and accomplishments of each of the
15 grantees, some of which are highlighted below:

-   California's surveys indicate high client satisfaction with CARE
    services that connect youth in juvenile facilities to recovery
    support services during and after incarceration.

-   The California Rural Indian Health Board's (CRIHB) use of online
    enrollment of clients and distribution of vouchers has significantly
    reduced time requirements for these activities.

-   Idaho has exceeded by 53 percent its target number of clients served
    by outreaching to residents of many rural communities and by
    providing culturally sensitive services to Native Americans and
    Hispanic communities.

-   Louisiana exceeded its target for clients served by 38 percent and
    recently added outpatient treatment with buprenorphine services as
    another clinical service.

-   New Jersey plans to offer small funding opportunities to the New
    Jersey American Indian community and faith-based providers
    struggling to start or expand services.

-   New Mexico increased the recovery support service voucher value and
    expanded services to include housing.

-   Texas has conducted training for all enrolled providers and
    participating courts.

-   Washington has established a strong collaboration with faith-based
    providers and partners who provide points of entry, housing,
    drug-free activities, and many more services.

-   Wyoming's ATR has integrated effectively with existing mental health
    and substance abuse providers, thus expanding capacity, and has
    streamlined the approval process for new providers.

Dr. Clark identified some challenges of the ATR application, such as the
need for ongoing support for peer leaders, ethics and risk management,
coordination and collaboration with other systems of care, monitoring
and evaluation, and sustainability. SAMHSA has provided technical
assistance to grantees on screening/assessment and recovery support
practices and services, methods to increase faith- and community-based
organizations' participation, and financial management, plus more
general assistance to grantees.

Dr. Clark announced that the future of ATR may be found in the
President's \$70 million proposal for Choice Incentive and
Methamphetamine Programs where States and tribal organizations that
voluntarily commit to using a portion of their block grant funds to
deliver substance abuse treatment through vouchers would receive
priority. Recipients could use up to 30 percent of their awards for
technical support to convert their treatment systems to vouchers.
Grantees would identify milestones, collect data, and document outcomes
through NOMs.

The House Appropriations Committee has supported a \$25 million
methamphetamine program, with vouchers optional, that would focus on up
to ten State grants where epidemiological and treatment data indicate
high methamphetamine and treatment prevalence. SAMHSA would use
methamphetamine funds to support clinical treatment, recovery support
services, and increased focus on participation of community- and
faith-based organizations.

**Council Discussion**

Ms. Sullivan asked the reason for a methamphetamine epidemic in Natrona,
Wyoming and in Appalachia. Dr. Clark responded that the drug's use has
swept across Western and Midwestern States, but that Wyoming and
Tennessee chose to submit grant applications specifically addressing
methamphetamine services while other jurisdictions address the problem
as part of their overall efforts. He suggested a review of the
methamphetamine problem at the next Council meeting.

**Connecticut Access to Recovery**

Commissioner Thomas A. Kirk, Jr., Ph.D., Department of Mental Health and
Addiction Services (DMHAS), State of Connecticut, described his State's
ATR program. The State uses recovery core values, elicited from the
addiction advocacy community, as a template to measure its activities.
Dr. Kirk considers substance abuse and mental health issues to be health
care issues and the agency to be a health care service agency promoting
value-driven sustained health and recovery through treatment and using
collaborative tools for its recovery support services.

Dr. Kirk observed that the field must take some responsibility for
stigma in terms of its language, for example, "serious and persistent
mental illness" and "chronic, relapsing disease." Instead of its
expensive acute-care orientation, the health care system should offer
recovery-oriented continuity of care to bridge gaps between episodes of
care, with recovery support services linked to the community to avoid
repeat episodes. Data showed that Connecticut was under-treating or
poorly treating significant numbers of people who went multiple times
into detox or inpatient psychiatric facilities. The agency's overarching
goal is a value-driven recovery-oriented system that offers the highest
quality of care at the most reasonable cost. Partnerships with the
recovery community and other state agencies and collaborative funding
sources are essential in providing tools to people in their recovery
process.

Connecticut's ATR program meshes with its existing service system and
builds on previous infrastructure activities. Through a Request for
Proposal (RFP), Connecticut funds a substance abuse treatment network in
each of its five regions. In the next couple of years, the State is
mandated to re-bid the entire service system for an opportunity for
funding. This would offer a way to ensure that ATR principles become the
driving force in service delivery. The 165 providers offer a choice of
peer, faith-based, and clinical approaches to recovery.

Dr. Kirk added that the Connecticut ATR program collaborates with a
variety of judicial and social service agencies to engage people and
intervene earlier in their substance use. It also funds Outreach and
Engagement Urban Initiatives that bring value-sustained recovery
services and support to people who are chronically homeless.
Connecticut's ATR offers a range of clinical services, including a new
focus on brief intervention and early-stage use, while other funding
sources support residential treatment. Recovery support services include
transportation, housing, vocational/educational services, tools, and
vouchers for food, clothing, and personal care. Dr. Kirk observed that
supportive housing decreases inpatient mental health and substance abuse
costs and increases employment, and vocational training doubles the
employment rate. These factors decrease the likelihood of acute care
episodes and high repeat admissions. He offered several representative
vignettes that describe various wraparound supports offered for people
in need of services.

Dr. Kirk noted that faith-based communities serve as a significant
source of new persons entering services, and the State's strong
peer-based advocacy community provides mentoring and other community
services. Two thirds of Connecticut's ATR funds go to recovery support
services and not to clinical services. Connecticut's ATR program
believes that this investment in recovery support services is necessary
in that it addresses barriers, establishes an environment supportive of
recovery, and provides the skills needed to initiate and build up
recovery capital.

Connecticut's program has served more than 10,000 people in two years,
although a proper planning process delayed service provision and most
people were served during year two. ATR received more than 75,000
service-level authorizations and paid claims of more than \$10 million.

Challenges include the arduous task of developing an administrative
infrastructure with providers to administer the voucher program, and
that grassroots organizations lacked the experience in processing
paperwork and GPRA recordkeeping. Lessons learned involve systems
change, the need for technical assistance and certification for
providers to collect required data, and inadequate attention to
sustainability of recovery support services.

Next steps for Connecticut's ATR include re-credentialing all service
providers for ongoing monitoring of quality of care, performance, and
resource efficiency; considering a network approach as the basic
framework for other funding streams; determining the comparative
effectiveness of recovery support services; and considering expanding
recovery support services into other funding sources.

**Council Discussion**

Mr. Curie thanked Dr. Kirk for envisioning ATR as a program that
operationalizes recovery and makes access to recovery a real goal in
people's lives. He also acknowledged the challenges of establishing a
voucher program and encountering expected delays in service delivery.

Mr. Stark noted that Washington State's ATR program navigates an
additional layer of government (counties and tribes) through which funds
pass down to service providers. Concerns include control,
accountability, and adequate staffing to implement the voucher system.
Nevertheless, Washington State sees ATR as an opportunity for
unprecedented flexibility to fill treatment gaps and provide recovery
support services. Additional treatment expansion funds in year two
permitted extending outreach and recovery support services into
communities even before people entered treatment, using that mechanism
to engage people to get additional treatment. In addition to traditional
recovery support services, unique services included fixing a person's
car, which was more cost-effective than paying for bus service to
commute to treatment, and dental care for a bad toothache, which enabled
the person to focus on his recovery plan. ATR provides flexibility and
choices otherwise unavailable from traditional funding sources.

Mr. Stark expressed concern about the possible loss of ATR and his hope
that other funding sources, such as the block grant, will become more
flexible to enable the services to continue. Mr. Curie noted the
importance of evaluating the overall efficacy and cost-effectiveness of
recovery support services, particularly nontraditional services, which
may offer shorter paths to achieving and sustaining recovery. He
encouraged advocacy for ATR and reiterated Congress's interest in ATR
outcomes.

In response to a question from Ms. Huff, Dr. Clark stated that while
there is no comprehensive evaluation planned for ATR, SAMHSA evaluates
outcomes by using the Government Performance and Results Act of 1993
(GPRA) data evaluation. Mr. Curie noted that ATR is the first treatment
program to operationalize NOMs, which will enable evaluation in terms of
attaining and sustaining recovery as defined by their 10 domains. The
budget request includes \$3 million for evaluation that is not present
in the House mark. Mr. Stark observed that States must evaluate
comparative outcomes for consumers assisted by ATR in order to justify
sustaining the services on the basis of quality and cost. Dr. Kirk urged
factoring continuity of care and quality of life into the evaluation
equation.

Dr. Gary asked about access to ATR services by poor and underserved
persons in jails and prisons upon their release. Dr. Kirk responded that
most referrals originate from the probation, corrections, and parole
systems, and that referrals are not as forthcoming from child welfare or
juvenile justice. Mr. Stark noted that Washington State's ATR has
targeted the child welfare system, and found that referral was a big
challenge. Dr. Clark pointed out that in the aggregate, the criminal
justice system is the largest point of referral in ATR, reflecting a
well-established partnership. He noted that CSAT collaborates with the
Departments of Justice and Labor to pair ATR grantees with their
discretionary grant programs to promote reentry into the community.

Dr. Clark responded to Ms. Huff that ATR programs vary in their focus on
serving young people. So, while California and Wyoming are funded for
specifically targeting adolescents, other States have targeted a wider
range of services and outcomes.

**Council Roundtable**

Mr. Stark urged SAMHSA to review evidence-based practice data for using
PROMETA in light of the potential for political pressure on States to
use it. Mr. Curie asked CSAT to take the matter under advisement, in
partnership with NIDA, to evaluate how to inform States.

**Public Comment**

Number range CHAPTER

Ms. Thelma King Thiel, Chairman and CEO, Hepatitis Foundation
International, noted that the foundation has trained 2,000 CSAT grantees
on the liver-wellness approach for prevention and recovery. Upcoming
studies find that the approach changes behaviors in programs for
injection drug users and homeless children. The foundation plans to
train 50 methamphetamine counselors at one university, and other schools
have expressed interest. She urged SAMHSA to issue RFAs in order to
streamline training people on the front lines.

Maj. Gen. Arthur T. Dean (Ret.), Chairman and CEO, Coalition of
Anti-Drug Coalitions of America (CADCA), noted that collaboration
between SAMHSA and CADCA's community coalitions has contributed to
dramatic reductions in substance abuse. Together with CSAP, CADCA has
published the first in a series of primers on the SPF to be used in all
CADCA's training. Maj. Gen. Dean presented a plaque to Mr. Curie to
recognize his leadership in the field and work with community
coalitions.

**Closing Remarks**

Mr. Curie thanked members of the Council for their ongoing commitment,
dedication, and support, in moving the agency's agenda ahead on behalf
of persons with addictive diseases and mental illnesses, and youth at
risk. He recognized the contributions of SAMHSA's leadership staff,
including Ms. Daryl Kade, Associate Administrator for Policy, Planning
and Budget, and Executive Director of SAMHSA's National Advisory
Council; Ms. Toian Vaughn, Executive Secretary of SAMHSA's National
Advisory Council; and Mr. Steve Wing, Associate Administrator for
Alcohol Prevention and Treatment Policy.

**Adjournment**

The meeting adjourned at 3:20 p.m.

I hereby certify that, to the best of my knowledge, the foregoing
minutes and the attachments are accurate and complete.

\_[3/13/07]{.underline} \_\_\_\_\_\_\_\_\_\_\_\_
\_\_[/s/]{.underline}\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date Daryl Kade

> Executive Director, SAMHSA National Advisory
>
> Council, and Associate Administrator for Policy, Planning and Budget,
> SAMHSA

Attachments:

Tab A -- Roster of Members

Tab B -- Attendees