Creating structural changes in State mental health and substance abuse systems: Findings from the national evaluation of the SAMHSA Co-occurring State Incentive Grant Program

While there is strong epidemiological evidence that mental health and substance abuse disorders have a rate of co-occurrence that is at least 50%, evidence of treatment rates demonstrates that persons are unlikely to be treated for both disorders. Under the assumption that there are structural barriers that prevent such persons from obtaining access to appropriate treatment, SAMHSA began a program of Co-occurring State Incentive Grants (COSIG) in 2003. Grantees were expected to address one or more structural problems including screening, assessment, licensing, workforce development, service coordination and network building, financing, and information sharing. To-date 19 states have received COSIG grants, with funds ranging from $2-4 million to be expended over a period of five years.

In late 2005 SAMHSA funded a national evaluation including the first 15 states to receive grants. The national evaluation is designed to assess how states what structural changes states elected to pursue and what progress they were able to make, as well as how they chose to organize in order to promote change. Two rounds of data collection have been completed, including review of all project documentation and extensive interviews with key informants at each site. This presentation will describe both the evaluation methods and evaluation findings-to-date.

Universal screening and workforce development are the goals that states most commonly pursued. Services integration, financing, and information sharing were less frequently chosen as goals. Most states had difficulty getting their programs started, frequently spending less that 50% of their initial year funding in the first year.