Does the Assistant Secretary for Mental Health and Substance Use Have a Leadership Problem?

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The latest issue of Friday Update has several posts related to the recent decision by Assistant Secretary for Mental Health and Substance Use Elinore McCantz-Katz's decision to either cancel or not renew 19 out of 34 technical assistance contracts. Community grant leaders, individuals, and professional organizations are pleading with the Assistant Secretary to reconsider her decision. If a recent article in the Washington Post is any indication, the likelihood of Dr. McCance-Katz changing her mind on her own is probably slim to none. In the article, Dr. McCance-Katz is quoted saying, “I want localized experts who know their communities,” she said. “We’re going directly to the source, essentially cutting out the middleman.”

All of this has me thinking about leadership.

Over the past few months, Dr. McCance-Katz has made more than a few controversial decisions. First, she abruptly canceled the National Registry for Evidence-based Programs and Practices (NREPP), then she severely curtailed evaluation requirements for grant programs, and most recently canceled or sent notice of non-renewal to more than a dozen technical assistance contracts. All of this being done in the name of cutting waste, saving money and giving grant communities more of a say in the type of support they receive from the federal government. Some estimate that the savings could amount to $50 million dollars, according to a SAMHSA official interviewed for a Washington Post article.

Unfortunately, these decisions were made so quickly; they left little time for federal government staff, contractors and communities to absorb, let alone react, to what had happened. This “shoot first, ask questions later” approach to management at SAMHSA is not a good look for the Assistant Secretary.

Here are a few examples of what is emerging as consistent management strategy from the Assistant Secretary’s office – broad stroke edicts with little or no clarity about how changes will effectively be implemented.

NREPP
When NREPP was canceled, and SAMHSA sent out an announcement saying that those activities would be handled by the National Mental Health and Substance Use Policy Lab, I made a quick call to SAMHSA to find out more information about the lab and was told a Director had been hired, but it had not been staffed. I feel for the new Policy Lab Director, who is going to have to hit the ground running to catch up with the Assistant Secretary’s new direction.

Evaluation
When the Assistant Secretary discontinued the evaluation contract for the Project Aware and Healthy Transitions grants, the message given to grant communities was that new grants would include an evaluation component focusing on the collection and analysis of NOMS data. And, SAMHSA staff would be responsible for collecting and analyzing this data. Oh my oh my, where are these magical “staff” going to come from? Surely, this data task won’t be assigned to the already overworked federal project officers? Well, we don’t know. And it is hard to discern if even the federal project officers know. Goodness.

Technical Assistance
When Dr. McCance-Katz shared her plan to revamp the way technical assistance is provided to communities, she stressed the importance of SAMHSA maximizing "its dollars that go directly to serving Americans." Dr. McCance-Katz cited a personal experience she had with a technical assistance provider as a way to justify (I guess) her decision to bring TA in-house. Dr. McCance-Katz also took a bewildering swipe at SAMHSA employees when she stated that “it is not the role of staff in Rockville, MD to determine what every community needs.” The comment felt gratuitous and seemed odd that she would call out the people who work for her in this way.

When contractors were told the news about the status of their TA contracts, many were instructed to embargo the news and not say anything to grantees until SAMHSA could provide appropriate language for them to use. According to some contractors, the news even appeared to surprise federal project officers.

And as you might expect, in this age of instant communication, word started to leak out to grant communities, but of course, the news was unclear, leading to rampant speculation about what was and was not true, who was on the chopping block and who was not.

Why Is the Children’s Mental Health Network Being Contacted by SAMHSA Grantees Outside of the Children’s Mental Health Arena?
Since the inception of the Children’s Mental Health Network, I have routinely received calls and emails from individuals involved with SAMHSA in the children’s space, asking why certain decisions have been made and what can be done to bring attention to particular issues. All very normal and fits with our mission of creating a forum for sharing ideas and opinions on ways to help strengthen and promote thriving communities in their efforts to enhance the lives of children, youth, and their families. I get these messages because people in the children’s mental health space know that by design, the CMHNetwork does not accept federal funds so that we can be free to speak out about various policy issues without fear of retribution or having limits placed on what we can and can not say.   

But things are different now. I am increasingly hearing from SAMHSA grantees and contractors from outside the children’s mental health arena. The messages and calls point to a lack of clarity and utter confusion about how decisions are being made at SAMHSA.

However, there is a personal toll reflected as well. The calls and emails that come in weekly share themes of bewilderment, fear about saying anything, anger, and sadness. For some, a lifetime of providing consultation to communities across America is coming to a crashing end. The impact for many contractors goes far beyond a theoretical construct of how TA should be provided. Jobs once felt to be secure, are now gone. Contractor families are being ripped apart as primary breadwinners scramble to figure out how they will pay the mortgage in the next few months.

Decisions about funding contracts, to be precise, should not be based on whether someone keeps their job or not, I am just trying to convey to readers the seismic impact these decisions have had to content experts across the country who are soon to be adrift. And the point of making this observation is that it feels doubly devastating because it came from left field, with virtually no notice.

Is There a Leadership Problem at the Assistant Secretary Level?
Grantees and contractors I have spoken with seem to share a general sense that the Assistant Secretary is making significant decisions based on her individual experience and bias, with insufficient input from diverse representation from communities across America, let alone SAMHSA staff. However, it is also possible that the Assistant Secretary has a robust feedback loop with community grantees, contractors and the staff who work for her, and the input I am receiving is incorrect. Either way, the public perception is increasing that decisions are being made in an executive fiat fashion, coming straight from the Assistant Secretary’s office with little or no outside input.

How Dr. McCance-Katz Can Fix This and Restore Faith in Her Leadership
The suddenness of the decisions to cancel NREPP, evaluation and the technical assistance contracts serves no one well. It would be wonderful if the Assistant Secretary would hit the pause button and hold a few regional forums where she brought together contractors, grant recipients and project officers for in-depth dialogue about how best to provide technical assistance.

And you know what? After such dialogue, the answer could be precisely in line with the actions the Assistant Secretary has taken, supporting her notion of stripping evaluation requirements and moving the decision-making about technical assistance out to the communities, "doing away with the middleman," as she says.

But she also might find that the answer to what works best is a bit more complicated than that. Either way, at least those of us on the outside looking in could have more confidence that major decisions like these were made after thoughtful planning and dialogue, both within SAMHSA, but more important, with those contractors providing services and the communities being served.

So how about it, Assistant Secretary McCance-Katz? Show your leadership chops and engage contractors (especially those you are letting go), community grantees and federal project officers in a robust dialogue about how to improve evaluation and technical assistance efforts funded by SAMHSA. I, for one, don’t see a downside to this. It would help break the (hopefully incorrect) perception that you are keeping yourself walled off inside the HHS Building, making decisions in isolation.

Network faithful – if you have thoughts about how Dr. McCance-Katz could more effectively engage grant communities and contractors in a dialogue about how to most effectively utilize federal dollars to provide evaluation and technical assistance, share your comments below. As well, send Dr. McCance-Katz an email and let her know!

With collective dialogue, we all learn and improve.

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scott

 Scott Bryant-Comstock
President & CEO
Children's Mental Health Network

 

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