Nationally, mental health, alcohol, and drug abuse treatment expenditures were $79.3 billion, or 8.1 percent of the $942.7 billion in total health care expenditures in 1996, with $12.6 billion spent on treatment for alcohol and other drug abuse (AOD). This represents a 10 percent decrease from 1986, when mental health, alcohol, and drug treatment expenditures were 9.0 percent of national health expenditures.
Since 1986, the average annual growth rate for all health care expenditures has been 8.3 percent, while the average annual growth rate of expenditures for alcohol and other drug abuse diagnoses has been 7.0 percent.
Public funding for substance abuse treatment grew from 53 percent of total substance abuse expenditures in 1986 to 63 percent in 1996. This was countered by a decreasing share of expenditures paid out-of-pocket, while private insurance payments remained relatively constant during this period.
Federal dollars, including the Federal portion of Medicaid, Medicare, DOD, VA, and the Substance Abuse Prevention and Treatment (SAPT) Block Grant, paid for 31 percent of national expenditures on AOD treatment in 1996. State and local contributions to AOD treatment expenditures were approximately equivalent at 31.5 percent.
SAMHSA's Center for Substance Abuse Treatment (CSAT) is the lead Federal Agency for substance abuse treatment, with responsibility for management of the $1.4 billion SAPT Block Grant. The SAPT Block Grant is is the cornerstone of the States' substance abuse programs, accounting for about 40% of the public funds expended for treatment and prevention. This is a formula-driven grant, and it includes several mandatory distributions and set-asides for allocations made to the States:
Federal funding for public treatment facilities, as reported on the block grant applications, ranges from 11%-84% of all funding being used for substance abuse treatment.
In 1997, nineteen States received the majority of their funding for support of substance abuse treatment services from the SAPT Block Grant.
Over 7,000 Community Based Organizations (CBOs) receive SAPT Block Grant funding.
It is estimated that the FY 1998 SAPT Block Grant funding supported treatment for approximately 300,000 drug-abusing persons. While estimates for the number of persons served who only abuse alcohol are not available, it can be estimated that approximately $500 million of the total SAPT Block Grant must be spent on alcohol prevention and treatment programs.
CSAT's other primary funding category, the Knowledge Development and Application Program, provides support for a wide variety of grants to States and other treatment entities in an effort to continually improve the quality of services, implement best practices, and expand service capacity. For example, in 1998, this initiative provided continuation funding of approximately $82 million for current programs, such as Residential Treatment for Women and Children, Starting Early Starting Smart (SESS) jointly funded by CSAP and CMHS, Supplemental awards for Children's Services, Criminal Justice, Managed Care and Vulnerable Populations, Wrap Around Services, Recovery Networks, Target Cities, Rural Remote and Culturally Distinct, Addiction Technology Centers, and others. CSAT also provided funding for the following new programs in 1998:
With an annual budget of nearly $5 billion, the Children's Bureau works with State and local agencies to develop programs to assist America's children and their families.
The Children's Bureau administers nine state grant programs and six discretionary grant programs. The state grant programs have their own legislatively mandated matching requirements and formulas for allocation and all require that the funds go to and be administered only by the State child welfare agency or, in some programs, Indian Tribes or Tribal organizations. The State agency can have agreements and contracts with other public agencies and with private agencies for provision of appropriate services. In the discretionary programs, the Administration for Children and Families policy requires a match from the grantees for all discretionary grant projects other than research.
The vast majority of Federal child welfare funding is spent on Title IV-E Foster Care and Adoption Assistance payments to States (described below). Most of the remainder goes to States in the form of the Child Welfare Services Block Grant (Title IV-B part 1) and the Promoting Safe and Stable Families (Title IV-B part 2) formula grant program. Several small discretionary grant programs, described below, provide demonstration funds to State and local agencies and other organizations for innovative child welfare activities.
The Title IV-E Foster Care program provides funds to States to assist with: the costs of foster care maintenance for eligible children; administrative costs to manage the program; and training for staff, for foster parents and for private agency staff. The purpose of the program is to help States provide proper care for children who need placement outside their homes, in a foster family home or an institution. Nearly $4 billion will be spent for these purposes in FY1999.
The Title IV-E Adoption Assistance Program provides funds to States to assist in paying maintenance costs for adopted children (AFDC or SSI eligible) with special needs, e.g., children who are older or handicapped. Funds are also used for the administrative costs of managing the program and training staff. The goal of this program is to facilitate the placement of hard to place children in permanent adoptive homes and thus prevent long, inappropriate stays in foster care. This program is expected to provide approximately $869 million to States in FY1999.
The Independent Living Program provides services to foster children who are 16 years or older to help them to make the transition to independent living by helping them earn a high school diploma or receive vocational training, receive training in daily living skills such as budgeting, locating housing, career planning and job finding; or otherwise make the transition to independent living. $70 million will be spent on the Independent Living program in FY1999.
The Safe and Stable Families Program (formerly called the Family Preservation and Support Services Program) encourages and enables "each State to develop and establish, or expand, and to operate a program of family preservation services and community based family support services." Family preservation services typically are activities to assist families in crisis, often families where a child is at imminent risk of being placed in out-of-home care because of abuse and/or neglect. Family support services are primarily preventive activities with the aim of increasing the ability of families to successfully nurture their children, most often provided at the local level by community-based organizations. This program will in FY1999 provide $275 million to States for these efforts.
The Child Welfare Services Program helps State public welfare agencies improve their child welfare services with the goal of keeping families together. State services include preventive intervention, so that, if possible, children will not have to be removed from their homes; services to develop alternative placements like foster care or adoption if children cannot remain at home; and reunification so that children can return home if at all possible. The funding level for this program has been stable at $292 million for a number of years.
Basic State Grants provide assistance in developing, strengthening, and implementing child abuse and neglect prevention and treatment programs. Eligible states must have established the following: a mandatory reporting law; procedures for the prompt investigation of reports; provisions to provide emergency services to protect reported children; provisions for immunity from prosecution for reporters; an assurance that a guardian ad litem is appointed in judicial proceedings to represent and protect the rights and best interests of the child; a system of preventive and treatment services and related multi-disciplinary programs and services; and a process in which reports and records are kept confidential and in which unauthorized disclosure is a criminal offense. States must also have programs and/or procedures in place to respond to reports of medical neglect, including instances of withholding medically indicated treatment from disabled infants with life threatening conditions. In FY1999, $21 million will be awarded participating States and Territories.
Community-Based Family Resource Program Grants are provided to States to develop and implement, or expand and enhance, a comprehensive, statewide system of community-based family resource services. To receive these funds, states must have established or maintained a trust fund or other funding mechanism that pools Federal, state, and private funds and makes them available for child abuse and neglect prevention and family resource programs. In FY1999, participating jurisdictions will receive grants totaling $33 million.
Children's Justice Act Programs help States to develop, establish, and operate programs designed to improve the investigation and prosecution of child abuse and neglect cases, particularly cases of child sexual abuse and exploitation, in a manner which reduces additional trauma to the child; and to improve the handling of cases of suspected child abuse or neglect related fatalities. Funds for this program are allocated from the Department of Justice's Victims of Crime Fund. FY1999 grants will total $8.5 million.
The Adoption Opportunities Program eliminates barriers to adoption and helps to find permanent families for children who would benefit by adoption, particularly children with special needs. The five major program areas, as mandated by the legislation, are: (1) the development and implementation of a national adoption and foster care data gathering and analysis system; (2) the development and implementation of a national adoption information exchange system; (3) the development and implementation of an adoption training and technical assistance program; (4) increasing the placements in adoptive families of minority children who are in foster care and have the goal of adoption with a special emphasis on recruitment of minority families; and (5) post-legal adoption services for families who have adopted children with special needs. A total of $25 million will be distributed through this program in FY1999.
The Child Welfare Training Program upgrades the skills and qualifications of child welfare workers through their participation, full-time or part-time, in programs focused specifically on child welfare services. Discretionary grants are awarded to public and private non-profit institutions of higher learning to develop and improve education/training programs and resources for child welfare service providers. The FY1999 funding level for these activities is $7 million.
The Child Welfare Research and Demonstration Program strengthens the family as the primary agent responsible for the developmental needs of children and youth. The Administration for Children, Youth and Families funds research, demonstration, dissemination, utilization and technical assistance activities in four basic areas: child welfare, child care, youth development, and child and family development. The resources budgeted for these four areas address the needs and problems confronting some of the most vulnerable children and families in the country: children in foster care, children in need of adoptive homes, children from poor families who require child care, and vulnerable youth who are runaways or homeless. No funds have been appropriated for this program since Fiscal Year 1995.
The Abandoned Infants Assistance Program is intended for development, implementation and operation of projects to demonstrate how to (1) prevent abandonment; (2) identify and address needs of abandoned infants, especially those with AIDS; (3) assist these children to reside with their natural families if possible, or in foster care; (4) recruit, train and retain foster parents; (5) carry out residential care programs for abandoned children and children with AIDS; (6) establish programs of respite care for families and foster families; (7)recruit and train health and social services personnel to work with families, foster families and residential care staff. Grants are made to public and nonprofit private entities. This program has enjoyed stable funding of $12.25 million per year for a number of years.
The Child Abuse Prevention & Treatment Act Research and Demonstration Projects are funds which support research on the causes, prevention, and treatment of child abuse and neglect; demonstration programs to identify the best means of preventing maltreatment and treating troubled families; and the development and implementation of training programs. Grants for these projects are provided nationwide on a competitive basis to state and local agencies and organizations. Projects have focused on every aspect of the prevention, identification, investigation, and treatment of child abuse and neglect. In FY 1999, approximately $14.2 million in discretionary funds will be awarded to support new and continuing research and demonstration grants, as well as evaluation, technical assistance and information dissemination activities.
The National Institute on Drug Abuse (NIDA) and the National Institute on Alcoholism and Alcohol Abuse (NIAAA) each conduct research on a variety of substance abuse topics, including basic research and studies of epidemiological, clinical, prevention, and services aspects of alcohol and illicit drug abuse and addiction.
Among NIDA's activities is a program of research on the health and development of children whose parents abuse illicit drugs. This effort is based on the following principles. Parental substance abuse had the potential to influence the development and the health of infants and children in many ways, via direct effects (e.g., prenatal drug exposure, postnatal passive drug exposure) and via indirect effects associated with drug abuse. Some of these indirect effect may be very specific (e.g., transmission of HIV from mother to infant) and some may be complexly interwoven (e.g., violence in the home and community and dysfunctional parenting associated with substance abuse). Outcomes of interest range from fetal development to infant and child developmental functioning, to vulnerability to drug abuse among these children and adolescents.
NIAAA supports a range of research on the etiology, prevention and treatment of alcohol-related family problems through two programs: one addressing alcohol-related violence, the other focusing on child development and family dynamics in alcohol-abusing families. Studies address both the direct and indirect effects of alcohol on developmental processes and on outcomes ranging from fetal alcohol syndrome to heightened vulnerability to alcohol-related problems over the life course.
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