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FY 2020 Annual Performance Plan and Report - Goal 2 Objective 3








  
  
    

  
      



Fiscal Year 2020

Released March, 2019



**Topics on this page:** Goal 2. Objective 3 | Objective 2.3 Table of Related Performance Measures

Goal 2. Objective 3: Reduce the impact of mental and substance use disorders through prevention, early intervention, treatment, and recovery support

Mental illness and substance abuse create health risks and place a heavy burden on affected individuals and their families. Substance use disorders arise from the recurring use of alcohol and/or drugs, which lead to clinically and functionally significant impairments. Mental disorders are health conditions that involve significant changes in thinking, emotion, and/or behavior and lead to distress and/or problems functioning in social, work, or family activities. Mental and substance use disorders are illnesses that impact people's ability to go about their daily lives in family, social, and professional settings and place individuals at risk of additional health problems. HHS works closely with federal, state, tribal, local, territorial, and community partners and stakeholders, including faith-based and community organizations, to help identify and address mental health problems and substance use disorders.

The Office of the Secretary leads this objective. The following divisions are responsible for implementing programs under this strategic objective: ACF, ACL, AHRQ, CDC, CMS, FDA, HRSA, IHS, IOS, OCR, and SAMHSA.

Objective 2.3 Table of Related Performance Measures

Reduce the age-adjusted annual rate of overdose deaths involving prescription opioids per 100,000 population among states funded through Prescription Drug Overdose Prevention for States program (Lead Agency - CDC; Measure ID - 7.2.6)22



FY 2013
			FY 2014
			FY 2015
			FY 2016
			FY 2017
			FY 2018
			FY 2019
			FY 2020Target
			N/A
			N/A
			11.9
			Baseline
			11.8
			11.8
			10.8
			10.8Result
			N/A
			13.3
			N/A
			15.0
			12/31/18
			12/31/19
			12/31/20
			12/3121Status
			N/A
			N/A
			Not
			Collected
			Historic
			Actual
			Pending
			Pending
			Pending
			PendingCDC tracks the rise of opioid overdose deaths and uses the data to pivot to prevention activities to curb this alarming epidemic. Opioids were involved in over 42,249 deaths in 2016, and opioid overdoses were five times higher in 2016 than 1999. In response to this growing public health crisis, CDC has launched its Overdose Prevention in States (OPIS)23 effort as means to equip states with resources and expertise needed to reverse this epidemic. As a part of OPIS, CDC's Prescription Drug Overdose Prevention for States (PfS) program funds 29 state health departments to advance and evaluate comprehensive state-level interventions for preventing opioid-related overdose, misuse, and abuse. This measure tracks progress in reducing overdose deaths involving all opioids among the 29 states funded specifically for PfS. In FY 2016 the baseline, age-adjusted annual rate of opioid overdoses was 15.0 per 100,000 residents among states funded for the PfS program. The PfS program will fund states through September 2019, at which point all the current OPIS programs will be replaced with one comprehensive new grant – Overdose Data to Action. Eligible entities include states, territories, and localities. CDC will continue to track the rise of opioid overdose deaths to monitor the impact of its prevention activities in FY 2020.

Increase the number of substance abuse treatment admissions with Medication-Assisted Treatment (MAT) planned as part of Opioid Use Disorder Treatment (Lead Agency - SAMHSA; Measure ID - 2.3.19K)24



CY 2013
			CY 2014
			CY 2015
			CY 2016
			CY 2017
			CY 2018
			CY 2019
			CY 2020Target
			N/A
			N/A
			N/A
			N/A
			N/A
			200,000
			220,000
			242,000Result
			N/A
			N/A
			223,407
			217,626
			08/31/19
			08/31/20
			08/31/21
			08/31/22Status
			N/A
			N/A
			Historic
			Actual
			Historic
			Actual
			N/A
			Pending
			Pending
			PendingSAMHSA expects the number of people receiving MAT and the number of admissions to substance abuse treatment with MAT to increase. States are continuing to develop their systems with increased resources from grant programs, such as the State Opioid Response grants, Tribal Opioid Response grants, and Targeted Capacity Expansion: Medication-Assisted Treatment Prescription-Drug and Opioid Addiction grants. Medicaid systems have increased their focus on opioid-related technical assistance, and outreach efforts from across HHS promote the use of MAT. SAMHSA uses data from the Treatment Episode Dataset (TEDS) to track the provision of substance abuse treatment for opioid use disorders, which includes tracking the planned use of MAT at admission.25 In CY 2015, 223,407 treatment admissions had MAT as a planned part of the treatment plan and 217,626 admissions had MAT planned in CY 2016. MAT data for CY 2017 will be made available in 2019. MAT data for CY 2018 will be available in CY 2020. SAMHSA will continue to monitor the use of MAT in CY 2019 and CY 2020.

Increase the availability of electronic clinical decision support tools related to safe pain management and opioid prescribing (Lead Agency - AHRQ; Measure ID - 2.3.8)



Fiscal Year
			Target
			Result
			StatusFY 2013
			N/A
			N/A
			N/AFY 2014
			N/A
			N/A
			N/AFY 2015
			N/A
			N/A
			N/AFY 2016
			N/A
			N/A
			N/AFY 2017
			N/A
			N/A
			N/AFY 2018
			Develop at least one new electronic clinical decision support tool related to safe pain management and opioid prescribing.
			Developed and tested a dashboard that aggregates pain-related information into one consolidated view for clinicians. Information includes data such as pain medications, pain assessments, pain-related diagnoses, and relevant lab test results.
			Target MetFY 2019
			1) Test, revise, and disseminate at least one new electronic clinical decision tool related to safe pain management and opioid prescribing and
			2) Partner with stakeholders to identify additional evidence-based electronic clinical decision tools related to safe pain management and opioid prescribing and make them publicly available.
			09/30/19
			In ProgressFY 2020
			Develop, test, and disseminate at least one electronic clinical decision support tool related to opioids or safe chronic pain management.
			N/A
			In ProgressAddressing the nation's opioid epidemic is an ongoing focus of AHRQ's Health Services Research, Data, and Dissemination portfolio. In FY 2017, AHRQ launched a new initiative to ensure that health care professionals have access to evidence supporting safe pain management and opioid prescribing at the point of care through electronic clinical decision support (CDS). CDS Connect is the infrastructure for developing and sharing these CDS tools.26

In FY 2018, AHRQ developed a dashboard that aggregates pain-related information from the Electronic Health Records (EHR) into one consolidated view for clinicians. The information includes data such as pain medications, pain assessments, relevant diagnoses, and lab test results. The dashboard was tested in partnership with Oregon Community Health Information Network, a network of community health centers, and uses the Health Level Seven Fast Healthcare Interoperability Resources standard, which allows for interoperability and implementation in different EHRs.

In FY 2018 and continuing in FY 2019, AHRQ will disseminate safe pain management and opioid-related CDS through CDS Connect. This includes the pain management dashboard developed in FY 2018. In addition, AHRQ will continue to work with its partners to disseminate safe pain management and opioid CDS tools. For example, CDC uses AHRQ's CDS Connect web platform as a dissemination mechanism for two opioid CDS tools that were developed by CDC and ONC. In FY 2019 and continuing in FY 2020, AHRQ will develop, test, and disseminate another electronic clinical decision support tool related to opioids or safe chronic pain management. AHRQ will continue to work with its partners and stakeholders on dissemination.

By 2020, evaluate the efficacy of new or refined interventions to treat opioid use disorders (OUD) (Lead Agency - NIH; Measure ID - SRO-4.9)



Fiscal Year
			Target
			Result
			StatusFY 2013
			N/A
			N/A
			N/AFY 2014
			N/A
			N/A
			N/AFY 2015
			N/A
			N/A
			N/AFY 2016
			N/A
			N/A
			N/AFY 2017
			N/A
			N/A
			N/AFY 2018
			Initiate at least one study to improve identification of OUD or evaluate the comparative effectiveness of available pharmacotherapies for OUD treatment.
			A Phase 3 clinical trial to test a non-opioid medication for managing symptoms of opioid withdrawal was completed.
			Target MetFY 2019
			Conduct 1 preclinical study and 1 clinical trial to develop non-opioid based medications to treat OUD that may avoid the risks of opioid dependence and overdose.
			12/31/19
			In ProgressFY 2020
			Conduct 1 pre-clinical and 1 clinical study of a longer acting formulation of a medication for the treatment of opioid use disorders or opioid overdose.
			12/31/20
			In ProgressThe misuse of and addiction to opioids such as heroin and prescription pain medicines is a serious national problem. This issue has become a public health epidemic with devastating consequences, which include increases in opioid use disorders (OUDs) and related fatalities from overdoses; rising incidence of newborns who experience neonatal abstinence syndrome because their mothers used these substances during pregnancy; and increases in the spread of infectious diseases, which include HIV and hepatitis C. This measure highlights one facet of NIH-funded research in providing scientific evidence to inform the public health response to the opioid crisis. In FY 2018, an NIH-funded Phase 3 clinical trial of lofexidine was completed, and the results were submitted to FDA.

Lofexidine is the first non-opioid medication for managing symptoms of opioid withdrawal in the United States, and FDA approved its use in May 2018. The drug provides a new option to help patients manage the excruciating physical symptoms of opioid withdrawal, which can be a major cause of relapse for those undergoing detoxification. Although medications have been available to treat opioid addiction, none have been approved to treat the physical symptoms of withdrawal. Approval of lofexidine (Lucemyra) is expected to facilitate detoxification and improve the success of detoxification, which will make treatment and recovery possible for many patients with opioid use disorder. In FY 2019 and 2020, NIH will continue to support research that explores new strategies for treating opioid misuse and addiction.

Increase the percentage of youth ages 12-17 who experienced major depressive episodes with severe impairment in the past year receiving treatment for depression (Lead Agency - SAMHSA; Measure ID - 2.3.19O)27



CY 2013
			CY 2014
			CY 2015
			CY 2016
			CY 2017
			CY 2018
			CY 2019
			CY 2020Target
			N/A
			N/A
			N/A
			N/A
			N/A
			48.0%
			48.5%
			50.0%Result
			N/A
			N/A
			N/A
			46.7%
			47.5%
			12/31/19
			12/31/20
			12/31/21Status
			N/A
			N/A
			N/A
			Historic
			Actual
			Historic
			Actual
			Pending
			Pending
			PendingWith states and the Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC) driving efforts to address the needs of children and youth with serious emotional disturbances, SAMHSA expects to see increases in the percentage of youth with a past year major depressive episode who receive mental health treatment. The National Survey on Drug Use and Health (NSDUH) defines treatment for depression as 1) Seeing or talking to a health or alternative service professional, or 2) Using prescription medication for depression in the past year. The most recent data available show that in CY 2017, 47.5 percent of youth ages 12-17 who experienced major depressive episodes with severe impairment in the past year received mental health treatment. SAMHSA has funded a number of programs to increase access to treatment, which include Healthy Transitions continuation grants and contracts for technical assistance and evaluation. In FY 2018, in addition to supporting contracts for technical assistance and evaluation, SAMHSA continued support for 14 continuation grants and supported 4 new grants. In CY 2019 and 2020, SAMHSA will continue to monitor major depressive episodes in youth ages 12-17, and the agency anticipates that these efforts made to improve access to services will lead to identifying reductions in the percentage of youth who report major depressive episodes.

Increase the percentage of adults with Serious Mental Illness (SMI) receiving mental health services (Lead Agency - SAMHSA; Measure ID - 2.3.19L)28



CY 2013
			CY 2014
			CY 2015
			CY 2016
			CY 2017
			CY 2018
			CY 2019
			CY 2020Target
			N/A
			N/A
			N/A
			N/A
			N/A
			67.0%
			68.0%
			71.0%Result
			N/A
			N/A
			N/A
			64.8%
			66.7%
			12/31/19
			12/31/20
			12/31/21Status
			N/A
			N/A
			N/A
			Historic
			Actual
			Historic
			Actual
			Pending
			Pending
			PendingWith states and ISMICC driving efforts to address the needs of individuals with serious mental illness (SMI), SAMHSA expects to see increases in the percentage of adults with SMI who receive mental health services.29 The most recent NSDUH data available show that in CY 2017, 66.7 percent of adults with SMI received mental health services. In CY 2019 and 2020, SAMHSA will continue to provide guidance to agencies on how to administer mental health services to individuals with SMI. Federal efforts, including ISMICC, discretionary grant programs, and SAMHSA's Clinical Support Services for SMI Technical Assistance Center will enable agencies to provide coordinated efforts and resources to individuals with SMI.

22This measure reports the number of overdose deaths involving prescription opioids per 100,000 residents. Targets and results have been adjusted for 2018 using data from the 29 funded states. The performance metrics reflect age-adjusted rates of overdose deaths involving all opioid analgesics per 100,000 population.

23https://www.cdc.gov/drugoverdose/states/index.html

24TEDS Annual Report, which is based on calendar year data, can be found at: https://www.samhsa.gov/data/sites/default/files/2016_Treatment_Episode_Data_Set_Annual.pdf

25MAT consists of provision of methadone, buprenorphine or extended-release naltrexone, in combination with counseling and behavioral therapies. TEDS is a compilation of client-level data routinely collected by the individual state administrative data systems to monitor their substance use treatment systems. Generally, facilities that are required to report to the state substance abuse agency (SSA) are those that receive public funds and/or are licensed or certified by the SSA to provide substance use treatment (or are administratively tracked for other reasons). TEDS records do not represent individuals; rather, each record represents a treatment episode. Thus, an individual admitted to treatment twice within a calendar year is counted as two admissions. TEDS does not include all substance use treatments. It includes treatment admissions and discharges at facilities that are licensed or certified by a state substance abuse agency to provide care for people with a substance use disorder (or facilities that are administratively tracked for other reasons). In general, facilities reporting TEDS data are those that receive state alcohol and/or drug agency funds (including federal block grant funds) for the provision of alcohol and/or drug treatment services.

26https://cds.ahrq.gov.

27NSDUH full 2017 report available at https://www.samhsa.gov/data/nsduh/reports-detailed-tables-2017-NSDUH.

28Ibid.

29In NSDUH, SMI is defined as having a diagnosable mental, behavioral, or emotional disorder, other than a developmental or substance use disorder. SMI was assessed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition—Research Version—Axis I Disorders (MHSS-SCID) which is based on the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). These mental illness estimates are based on a predictive model. Additionally, ‘Mental Health Services’ in the NSDUH is defined as having received inpatient treatment/counseling or outpatient treatment/counseling or having used prescription medication for problems with emotions, nerves, or mental health.

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Content created by Office of Budget (OB) Content last reviewed March 29, 2019 Back to top
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