Detailed Key Findings from the Independent 

Evaluation of the SAPT Block Grant Program

U.S. Department of HealtH anD HUman ServiceS

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Treatment

Center for Substance Abuse Prevention

http://www.samhsa.gov
Key Finding 1: The SAPT BG Program has demonstrated 

a positive effect on the health and lives of individuals with 

substance use disorders. 

Through participation in treatment programs 

funded by the SAPT BG, individuals with substance 

use disorders have demonstrated positive outcomes 

in all six client-level National Outcome Measures 

(NOMs) domains: alcohol and drug abstinence, 

employment/school participation, stable housing, 

social connectedness, criminal justice involvement, 

and retention in treatment. States report treatment 

NOMs either through submission of their own data 

collected from BG-funded providers or through 

pre-population of NOMs data fields with data from 

the Treatment Episode Data Set (TEDS). Regardless 

of which data collection and reporting method 

States choose, treatment NOMs are collected using 

the following TEDS data definitions:

•	 Client: An individual who has an alcohol or drug 

related problem, has completed the screening 

and intake process, has been formally admitted 

for treatment or recovery service, and has his or 

her client record 

•	 Admission: The first date of service, prior to 

which no service has been received for 30 days 

•	 Discharge: The last date of service, subsequent 

to which no service has been received for 30 

days. 

Clients showed positive outcomes in all six 

client-level National Outcome Measure (NOM) 

domains: 

Increased Alcohol Abstinence 

Admission 44% 

Discharge 64% 

Increased Employment and School Participation 

Admission 36% 

Discharge 44% 

Increased Social Connectedness 

Admission 43% 

Discharge 64% 

Increased Drug Abstinence 

Admission 40% 

Discharge 59% 

Increased Stable Housing 

Admission 92% 

Discharge 94% 

Decreased Criminal Justice Involvement 

Admission 33% 

Discharge 12% 
Key Finding 2: The SAPT BG Program has acted as a major 

impetus for improving State prevention and treatment 

systems’ infrastructure and capacity.

SAPT BG Program emphasis on demonstrating the effectiveness of BG-funded 

programs and services to reduce substance abuse and to improve the lives of 

those affected by it has driven State system infrastructure development and 

capacity improvements. BG requirements have incentivized States to address the 

effects of substance abuse in at-risk populations by using innovative evidence-based strategies and have 

laid the foundation necessary to build comprehensive client data systems. Specific outcomes include:

Outcome 1. Increased Availability of 

Services for Diverse and Underserved 

Populations 

Women and Children: The BG requirement for 

women’s treatment has resulted in a growth of 

more than 50% for women’s treatment services 

expenditures since the beginning of the legislative requirement in FY 1994. 

IV Drug Users: States offered comprehensive 

services for IVDUs in accordance with SAPT BG 

set-aside requirements. Methadone programs 

were the most frequently reported service provided, followed closely by outreach initiatives. 

HIV Services: States provided a range of services, including HIV testing, HIV/AIDS/STD risk 

and prevention education, individual and group 

counseling, and case management services.

Outcome 2. Increased Development 

and Implementation of Evidence-Based 

Practices (EBPs) 

From FY 2005 to FY 2007, States demonstrated 

a substantial increase in the number of EBPs 

in SAMHSA’s National Registry of Effective 

Practices and Programs (NREPP) used with 

clients. States implemented 22 NREPP EBPs in 

FY 2005 and 119 EBPs in FY 2007. Prevention 

and parent education EBPs showed the greatest increase in use from FY 2005 to FY 2007. 

Outcome 3. Improved Development and 

Collection of Specific Outcome Measures 

•	 BG data collection and set-aside requirements have served as the impetus for 

uniform, consistent data collection in States. 

•	 Collection of outcome measures offers 

States a profile of activities oriented toward prevention and treatment. 

•	 Development and collection of data 

focuses on outcomes. 

Outcome 4. Increased Development and 

Maintenance of State Data Management 

Systems 

State data management systems necessary to 

collect required outcome measures for the BG 

Program have catalyzed service integration 

and coordination across and within States, led 

to the development of data infrastructures 

such as electronic health records (EHRs), and 

provided the ability to report outcomes within 

and across States. 
Key Finding 3: States have leveraged SAPT BG Program 

requirements, resources, and Federal guidance to sustain and 

improve their State systems.

Outcome 1. Prevented Harm to the 

Service System Resulting from State 

Legislature Reductions in Funds for Prevention and Treatment and Advocated for 

Additional Funding

Using the legislative requirements included 

in the BG application template and guidance, 

States have gained leverage with their legislatures and other funders of substance abuse 

prevention and treatment services. BG requirements, especially the maintenance of effort 

mandate, offer State substance abuse agencies 

a certain level of budgetary “protection” and 

are helpful and effective in keeping substance 

abuse services available. 

Outcome 2. Set State Policies and 

Priorities Based on Federal Leadership and 

Development of National Policies and 

Priorities 

•	 States have used BG funding and its requirements to advocate for a variety of State 

policy and priority changes, including: 

•	 Directing State Medicaid and BG resources 

into the foster care system

•	 Drug enforcement policies

•	 Mental health and substance abuse services for the criminal justice population

•	 Incorporation of evidence-based practice 

requirements into licensure regulations

•	 Youth access to tobacco

•	 Women’s-specific treatment standards.

Outcome 3. Used BG Funds as Seed 

Money for New Programs that Other 

Public and Private Organizations Have 

Subsequently Funded 

More than half of States interviewed (12) 

reported having used SAPT BG funds to initiate 

programs that have subsequently continued 

with State and other funding sources. The 

remainder of States interviewed (9) noted that 

although no programs have been completely 

shifted from BG funding, most now receive a 

combination of State, Federal, and other funding 

sources; many programs that began with only 

BG-funding have expanded their funding base. 
Key Finding 4: Through a standard system of communication, 

monitoring, and reporting, CSAT, CSAP, and the States 

effectively and efficiently manage the SAPT BG Program.

A nationwide grant program as complex as the SAPT BG Program requires 

effective and efficient management to coordinate a myriad of Program activities 

across diverse States. CSAP and CSAT have developed several successful management strategies to steer States as they work toward the 17 legislative goals.

Outcome 1. Communicated Program 

Goals and Activities to Create a Standardized System

CSAT and CSAP communicate Program goals 

and expectations through the dissemination 

of the BG application guidance and template, 

which conveys the proper structures for 

reporting past, present, and planned activities 

related to the State’s compliance with the 

Program’s 17 legislative goals. The application 

template guides the States in the creation of 

a single document that includes an annual 

report, a progress report, and a State plan. 

Outcome 2. Provided Monitoring and 

Oversight to Facilitate Open Communication

Monitoring and oversight activities—the 

application review and approval, technical 

reviews for treatment services, prevention 

and Synar system reviews, and Federal data 

collection activities—encourage open and 

flexible communication among Federal, State 

and subrecipient levels. Application review 

and approval activities are a major source of 

communication that leads to a longer-term 

collaborative Federal-State relationship. 

Outcome 3. Led Complex Data Collection and Reporting Processes

CSAT and CSAP are using the National Outcome 

Measures (NOMs) to document client and 

system level outcomes. States experienced the 

following outcomes related to Federal data 

collection and reporting activities:

•	 Development and improvement of State 

data collection capacity

•	 Identification of State and subrecipient 

TA needs

•	 Identification of trends within and between States

•	 Catalyst for States to focus on data quality.

Outcome 4. Provided TA and Training to 

Ensure Compliance and to Aid States in 

Meeting their Goals

The Federal TA and training process has several 

strengths, which include that it provides 

access to skilled experts, involves responsive 

SPOs, features a user-friendly TA tracking 

system and consultant database, provides 

access to high-quality data collection and 

management training, and offers a range of TA 

topics to accommodate different State needs. 
Key Finding 5: The SAPT BG Program has contributed to 

the development and maintenance of successful State 

collaborations with other agencies and stakeholders 

concerned with preventing substance abuse and treating 

substance use disorders.

Outcome 1. Increased Achievement of 

Synar Program Goals and Objectives

To realize Synar program goals, Single State 

Agencies for substance abuse (SSAs) collaborated with a wide variety of State agencies, 

advisory committees, tobacco retailers, and 

research universities. SSAs reported that the 

Synar program fostered much collaboration 

with other State agencies and local organizations that otherwise would not have been 

initiated or maintained.

Outcome 2. Improved Coordination of 

Prevention Services

SSAs coordinated with a variety of agencies and 

organizations to ensure appropriate and effective statewide prevention services. Prevention 

education and community-based initiatives 

were among the prevention strategies that 

most commonly involved such collaboration.

Outcome 3. Improved Coordination of 

Treatment Services 

The majority of States initiated interagency 

agreements, including formal memoranda 

of understanding, to improve the continuum 

of care for treatment program clients. They 

established interagency agreements to ensure 

that clients were provided services such as 

prenatal and child care; tuberculosis and HIV 

screening, education, and treatment; and 

vocational rehabilitation. 

Outcome 4. Expanded Services and 

Programs Available through Joint Funding Initiatives

In addition to improving the coordination 

of treatment and prevention services, SSAs 

collaborated with other State agencies to 

expand access to substance abuse services 

through joint funding of programs and initiatives. Using SAPT BG funds, SSAs co-sponsored 

a variety of services and programs, including 

treatment programs for women, HIV services, 

and prevention services. 

Outcome 5. Increased Ability to Address 

Critical Public Health or Safety Issues 

Statewide 

SSA collaborations with other State agencies and local stakeholders enabled them to 

address specific public health or public safety 

related concerns. A number of SSAs reported 

participation on task forces, interagency workgroups, and legislative committees designed 

to plan and implement strategic activities 

to mitigate public health problems. Specific 

examples of issues addressed included: Fetal 

alcohol spectrum disorders, treatment needs 

for children and adolescents, alcohol misuse 

and abuse on college campuses, prescription 

drug abuse, housing and homelessness, tribal 

health, and substance-related crime. 
Key Finding 6: Although baseline data support the need for 

prevention services and activities, the use of national survey 

State estimates data alone to assess the NOMs limits CSAP’s 

ability to attribute changes in the NOMs to SAPT BG-funded 

prevention services and activities.

As part of the NOMs initiative to increase accountability and improve the ability to demonstrate 

program outcomes, CSAP collaborated with national, State, and local prevention organizations to 

develop outcome measures. These measures examine attitudes toward substance use, abstinence, 

school or employment participation, criminal justice 

involvement, and social connectedness. To reduce 

the data collection burden for State and local 

prevention agencies (which receive only 20 percent 

of SAPT BG funds), CSAP uses data from the NSDUH 

to fulfill NOMs data requirements. There are two 

significant difficulties inherent in this strategy:

•	 Conclusions about NOMs changes as a result of 

BG-funded prevention services and activities 

cannot be made based primarily on the results 

of national survey State estimates that do not 

identify individuals or groups who may have 

been affected by BG-funded activities. Additional data are needed to link changes in NOMs 

measures to interaction with BG-funded prevention services and activities.

•	 The NSDUH is limited by small sample sizes in 

many States, which leads to under coverage of 

some populations, including individuals and 

groups who have been affected by prevention 

services and activities.

States may request to substitute data instead 

of utilizing the NSDUH survey State estimates. 

States also provide their own specific data on EBP 

implementation and the number of persons served. 

CSAP has convened an expert panel that has 

provided recommendations on revising the NOMs 

data collection and analysis strategy in order to 

demonstrate the effectiveness of SAPT BG-funded 

prevention activities. Analysis of NSDUH data 

across years will enable the assessment of general 

population change related to the NOMs; however, 

without a data source more proximal to prevention 

interventions, it will not be possible to determine 

the extent to which changes can be attributed to 

BG-funded prevention services and activities.