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An open letter to Senator Tom Harkin – What happened to HTI?

August 18, 2013

In 2009 the Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, funded seven states five-year cooperative agreements to participate in the Healthy Transitions Initiative (HTI). This initiative was designed to integrate services and supports for youth and young adults 16-25 with serious mental health conditions and their families. One of the unique aspects of the original HTI funding is that it only went to states and the states were asked to craft practice and policy. This combination of practice informing policy and policy impacting practice was deemed critical to replication and sustainable change to create better outcomes and create supportive state-level policies.

Funding for a new round of HTI grants was included in the President’s budget for 2014 but was removed without explanation from the Senate Appropriations bill. We have sent the letter below to Senator Tom Harkin (D-IA), Chairman of the Labor, Health and Human Services, and Education Appropriations Subcommittee to help us better understand what happened. For an in-depth review of the chronology of events, click here.


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August 16, 2013

The Honorable Tom Harkin
Chairman, Subcommittee on Labor,
Health and Human Services,
Education and Related Agencies
Committee on Appropriations
United States Senate, Washington, DC

Dear Chairman Harkin,

The Children’s Mental Health Network has been following the FY 2014 Labor, Health and Human Services, Education and Related Agencies appropriations bill with great interest but have some concerns that we hope you can address.

We were pleased to see that proposed funding for the Healthy Transitions Initiative (HTI) as part of the Substance Abuse and Mental Health Services (SAMHSA) budget was included in the President’s budget proposal to Congress. As you may know, young people with serious mental health conditions, particularly those involved with the public mental health system, often face a more difficult transition to adulthood and the successful assumption of adult roles and responsibilities compared to their peers with or without other disabilities. While these youth have ongoing needs for clinical services, they also have significant needs for support services that facilitate independent living and the ability to make wise choices as young adults. The unique service needs of these young adults extend beyond those of children and younger adolescents, and they differ from those of adults. The Healthy Transitions Initiative creates developmentally-appropriate and effective youth-guided local systems of care to improve outcomes for youth and young adults with serious mental health conditions in areas such as education, employment, housing, mental health and co-occurring disorders, and decrease contacts with the juvenile and criminal justice system. These local systems are linked and integrated at the State/Tribal/Territorial levels in order to effect policy change and replication statewide.

This is exactly the kind of comprehensive, forward thinking that we have come to expect from SAMHSA. And, we at the Children’s Mental Health Network have thoroughly enjoyed watching and learning from the seven funded HTI state initiatives, especially with the growing important involvement of young adults participating in the design and delivery of services and supports that most effectively meet their needs. So we were thrilled, but by no means surprised, when we saw that proposed funding for the HTI was included in the President’s budget proposal to Congress.

However, we were gravely concerned when we reviewed the Senate markup and found no mention of the HTI. We did, however, notice the addition of a new 5 percent set-aside within the Community Mental Health Services Block Grant that will allocate $24,817,000 to be disbursed among all 50 States. The specific language reads “Provided further, That States shall expend at least 5 percent of the amount each receives for carrying out section 1911 of the PHS Act to support evidence-based programs that address the needs of individuals with early serious mental illness, including psychotic disorders, regardless of the age of the individual at onset.” 

At first glance it appears to us that $25 million was removed for HTI funding and close to $25 million was added to the Community Mental Health Services Block Grant. Even more concerning to us is that there is no justification that we can find for why the HTI line item was removed. From our view it appears that funding for a comprehensive, community-based, youth and family driven initiative has been deleted and that funds for “evidence-based programs addressing the needs of individuals with the early signs of serious mental illness, including psychotic disorders, regardless of the age of the individual at onset” is in, to be distributed through the Community Mental Health Services Block Grant. This type of shift in funding from a focused grant initiative to Community Mental Health Services Block Grant funding for treatment approaches that address the needs of a very small percentage of the overall population of focus (further complicated by the fact that the population of focus in the Community Mental Health Services Block Grant funding is vaguely defined), is woefully inadequate in the larger context of preparing communities for what is needed to support young adults and their families.

Our hope is that you can shed some light on how these changes were made so that we can better understand the rationale of both removing HTI funding and adding funds to the Community Mental Health Services Block Grant. Understanding the process will help us inform our members on education approaches necessary to help decision-makers fully understand the value of a comprehensive approach to meeting the needs of emerging adults and their families.

Please help us understand the following:

  • How was the decision made to remove HTI funding? What was the rationale to support this decision? Who was involved in making this decision?
  • How was the decision made to add funding to the Community Mental Health Services Block Grant? What was the rationale to support this decision? Who was involved in making this decision?
  • In the descriptive language concerning the addition of funds to the Community Mental Health Services Block Grant it reads in part “support evidence-based programs that address the needs of individuals with early serious mental illness, including psychotic disorders, regardless of the age of the individual at onset…” What is the age range considered to fit this population of focus?
  • What is the rationale for spreading these additional $24,817,000 across 50 states? From our perspective effective and lasting change takes a concentrated effort. Diluting funds across all 50 states through the Block Grant provides for a lukewarm effort at best. Concentrating efforts on a finite number of grants with more robust funding allows for system transformation efforts to take hold – a much more effective use of federal funds.
  • In the report that accompanies S. 1284 it is noted that “The Committee directs SAMHSA to collaborate with NIMH in developing guidelines to States regarding effective programs funded by this set-aside.” What will be the criteria for these guidelines? How will lessons learned from the effective SAMHSA funded Healthy Transitions Initiative programs, currently operating in 7 states, be incorporated?  
  • Beyond developing guidelines, what type of technical assistance and oversight will be provided? Who will provide such oversight and assistance?

Thank you for your interest in this issue and for taking the time to answer these questions for us.

Sincerely,

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

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