Two short weeks ago, Dr. Elinore F. McCance-Katz, Assistant Secretary for Mental Health and Substance Use, SAMHSA, posted a blog sharing her thoughts about SAMHSA's use of contractors to provide technical assistance to grantees. It was not a favorable assessment, and in the post, Dr. McCance-Katz declared that SAMHSA would "no longer continue a contractor-driven approach to grantee-specific TA."
In her post, Dr. McCance Katz stressed the importance of SAMHSA maximizing "its dollars that go directly to serving Americans." Dr. McCance-Katz stressed that she sees it as her role to "reform agency practices to serve communities more efficiently and to identify ways to fund even more services with current resources."
So far so good. It's hard to disagree with a commitment to utilizing federal funds wisely. But as the post goes on, the logic begins to unravel a bit. One of the striking rationales Dr. McCance-Katz cited as part of her decision-making was a bad experience she had with technical assistance as an employee of a SAMHSA grant. She wrote:
I once was quite puzzled when a SAMHSA contractor put together a training for three days to provide TA for me – in an area for which I required no help. This practice will not continue any longer.
Okay, I get that she had a bad experience. Most of us who have worked on grants have had our share of both good and bad experiences with technical assistance. But what did she do at the time she had this "bad experience?" Did she tell her manager? Did she share the assessment of the experience with her federal project officer? And how did things get to the point where a three-day training was prepared for "her" without her involvement?
Making such a stark proclamation about TA without any context seems a bit reckless for someone who is deciding the fate of technical assistance for an entire agency (SAMHSA). And a nation of grantees who depend on SAMHSA for support, guidance and the cultivation of a forward-thinking approach to identifying effective strategies for meeting the needs of individuals and families with mental health and substance use challenges.
Consider this next broad stroke statement in the Assistant Secretary's post:
I believe in the value of TA and feel strongly that one of SAMHSA’s roles is to provide this type of service; however, I do not believe the government or its contractors are best equipped to determine the needs of a grantee. I believe that grantees know their programs and their needs best. It is not the role of staff in Rockville, MD to determine what every community needs.
Changing the way SAMHSA does business – to be less reliant on an antiquated system that has depended on external contractors – will enable the agency to realize millions of dollars in savings. These savings will be turned back to America’s communities through the funding of more grants to implement the much-needed programs and services for those living with mental and substance use disorders. Individuals, families, communities, and the nation at large deserve better than what they have been getting."
Wow. I just can't let this go unchallenged. I have worked with federal project officers, grantees and a myriad of technical assistance contract providers dating back to the first term of the Ronald Reagan Administration. And guess what? There have been a bunch of good ones, a few bad ones and a few excellent ones. Dr. McCance-Katz is right that no government official alone, or a contract TA provider alone, knows best what a grant community needs. To spread shade on the staff of SAMHSA by saying that "it is not the role of staff in Rockville, MD to determine what every community needs" is a real head-scratcher. Of course, it isn't. And in the 35 + years I have been involved in this work, the few federal employees and contractors who thought they, alone, held the answer, stand out clearly in my mind. You know why? Those of us who have worked in grant communities can smell a rotten egg a mile away. Individuals like that may have their day for a while, but they get sniffed out fairly quickly, and karma being what it is, they eventually become isolated and irrelevant.
But more important, just as a federal project officer or a contract TA provider is not the sole source of knowledge, it is not a given that grant communities are going to necessarily know everything they need - especially if they are involved in conducting cutting-edge research and practice. When I worked for the Department of Mental Health in North Carolina years ago, under the leadership of Lenore Behar, because of her stature, I figured I knew everything. Ouch. I couldn't have been more wrong. But think if I had been unleashed to base my TA requests on my view of the world or the fact that my boss was the one who originally coined the term "wraparound?"
Unleashed to decide what was best for a grant without any checks and balances is a potent elixir. But with that power comes a potential pitfall to not engage in thoughtful dialogue that might stretch your comfort zone and get you to think outside of the box. It's easy to use TA money to hire consultants to come in and tell you what you want to hear. But where is the growth and innovation in that? It's a bit more difficult, yet ultimately more rewarding, to be a part of a TA community where you can embrace the challenging of your assumptions in a supportive and solution-oriented way.
And that is the power of a dynamic interplay between grant community, external expertise, and the federal government. All bring essential components to the table. And this is not to say that you can't make dollars available to grant communities to identify specific TA for their individual needs. One of my favorite examples of this is from the experience of a Child Mental Health Initiative grantee in California some years ago. The grant had a specific focus on utilizing a wraparound approach in designing services and supports for youth and families. Plenty of expertise on this topic was available from the external contractor to SAMHSA overseeing technical assistance to grant communities. But this community had a specific challenge. They had a large Hmong community that they were serving, and the training on wraparound didn't fit the cultural context of the Hmong community. So they worked directly with leaders of the Hmong community to develop a service delivery approach that would work, which was expertise the contracted TA provider could not provide.
So, you say, Dr. McCantz-Katz is right, right? In that specific case, yes. And having visited grant communities across the nation over the past 30 years, I can think of many examples like that. But developing new community-based initiatives are complex ventures that have a lot of moving parts. No one can be an expert on everything. Yes, there are elements that a grant recipient will know better than anyone else. But the dynamic relationship of intermingling community-specific expertise with external resources who can help identify strategies (similar and dissimilar) in other parts of the country, along with federal oversight to ensure dollars are being used to support the goals and objectives of the funded grant is the synergistic dance we should be striving to achieve.
This "new approach" that SAMHSA is taking extends to evaluation as well: Dr. McCance-Katz writes:
SAMHSA’s role in evaluating its programs is no different. I see evaluation as a critical need for all SAMHSA programs. I am committed to ensuring that all SAMHSA programs are evaluated in a robust and high-quality manner; however, this does not necessitate spending millions of dollars to fund external contracts to do this. SAMHSA will be bringing much of its evaluation work in-house. Grantees will no longer be asked to collect reams of data that this government agency doesn’t even use. We will, instead, be collecting key outcome measures, which federal staff will utilize to analyze programs’ successes and areas for improvement.
This move to bring work 'in-house" just amplifies the basic question of "how" and by "whom?" It seems like there is a lot of broad stroke emphasis on saving money, getting rid of external contractors and doing things on the inside. That's great and is a perfect slogan for a parade. But for those of you who have worked with, or currently work with SAMHSA staff, you know that they are already overworked. Who are the SAMHSA staff who are going to pick up this extra work? Scarily, maybe the more important question is "What will get left by the wayside, due to the crushing burden placed on already overworked federal employees?"
I can't think of anyone doing this work who doesn't agree that if there is terrible technical assistance or unproductive evaluation, it should be rooted out and addressed. But to make broad stroke statements about a generalized perception of ineffective federally funded technical assistance to grants ("deserve better than what they have been getting.") serves no one's best interest. The statement is demoralizing to the hard-working employees of SAMHSA, the broad network of TA providers and the people in communities across the United States and its territories which participate in these grant programs.
I am of the firm belief that Dr. McCance-Katz, like all of us, is doing the best she can with the resources she has available to her. I encourage readers of Morning Zen to contact Dr. McCance-Katz and share your thoughts about the importance of a comprehensive technical assistance approach to SAMHSA grantees.
Your message doesn't have to be fancy. In fact, short and sweet is probably best. The email address for Assistant Secretary McCance-Katz is
Writing an email message to Dr. McCance-Katz provides you a valuable opportunity to help broaden her view of the importance of what a robust technical assistance approach could and should, entail.
UPDATE: On Wednesday of this week, word began to spread that several technical assistance contracts with external providers had been abruptly cut. Our phones have been understandably ringing off the hook from people in grant communities trying to figure out what is going on. If you have a story to tell about your experiences with technical assistance, good or bad, send me an email at email@example.com. I am preparing an update on developments for the next issue of Friday Update.
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Read the Advocacy Tales cartoon that references this Morning Zen Post here.
President & CEO
Children's Mental Health Network