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Answer. The 400 hour estimate represents an average of all reporting units consisting of awards from $59 thousand to $151 million. Because the reporting requirements are intended to establish how the State spent their award and what their treatment needs are, the actual report preparation time will vary in direct proportion to the size of each state's award. New Hampshire, receiving a smaller award, should expect to spend considerably less time on the report. Costs associated with this paperwork burden are supported by the administrative cost allowance in the ADMS block grant.
We are sensitive to reducing the reporting requirements and have taken or shall be taking the following steps: setting page limits on all narratives and rearranging the voluntary State Plan to offset ma jor requirements of the annual report.
Question. Can information collection requirements imposed by ADAMHA on the States be reduced administratively or are they the result of legislative mandate?
Answer. The information collection requirements could be administratively reduced by ADAMHA; however, prudent Federal management of the ADMS Block Grant dictates that a minimal data set on State's activities and plans be compiled. The voluntary combined State Application and Plan, in the main, focuses on the compliance issues of Section 1916 of the Public Health Service Act, and the responsibilities of the Secretary in Sections 1917 and 1918. In addition, the data are necessary for the DHHS to be in compliance with the Federal Financial Manager Integrity Act.
The data being collected from the States describe how the money was spent and how many people are in need of services supported by the Block Grant. Our failure to have had this most basic information the past has led to wide criticism from Congress, GAO, and the DHHS Inspector General.
Question. Last year, New Hampshire Alcohol and Drug Abuse completed nine different needs assessment surveys on training which were generated by the Office of Substance Abuse and Prevention. Many of these surveys requested the same basic information but they were prepared by the different contractors and used somewhat different formats.
States are being urged to collaborate and cooperate; yet it appears this message is not being followed at the federal level. What can ADAMHA do to reduce overlap and the collection of duplicative information being requested of our State programs?
Answer. In developing and implementing a fully comprehensive training program, OSAP has undertaken a large, global needs assessment survey intended to assess the training needs for a variety of interrelated though diverse populations such as health professionals, allied health professionals, preventionists, social workers, community coalition members, parents, and others. Because of the distinctness of each of these populations, it has been necessary for OSAP contractors to query States for information specific to the populations each osad initiative is intended to address. While this may appear as multiple requests to the States, all inquiries are, in fact, part of a larger needs assessment survey. Effort is made within OSAP to share information among the program initiatives in order to limit the burden placed on the States for information.
NIMH NATIONAL PLANS
Question. The National Advisory Mental Health Council will shortly release a report on a National Plan of Research to Improve Care for Severe Mental Disorders. Can you provide a preview of the recommendations contained in this plan?
Answer. We are very excited about the promise of the new research field developed in this plan. With the help of three panels of experts, and many consultants throughout the Nation, this Council Report has formulated recommendations that lay the basis for a new effort to bring the full power of scientific research to the quest for improved services for the millions of people with severe, persistent, disabling mental disorders. Specific focuses of the plan are :
Improving quality of care. Research is needed on methods to: (a) improve diagnosis and assessment of rehabilitation potential for mentally ill individuals; (b) apply treatment and rehabilitation in the most effective ways in daily clinical settings; and (c) assure that state-of-the-art diagnosis and treatment is available to everyone who needs mental health services. Special emphasis is placed on how best to combine medication, psychosocial treatments, and rehabilitation methods into effective treatment plans for each individual, that are consistent with consumer and family goals while accounting for variations in culture and personal characteristics. Investigators must develop measures of outcome that do justice to the full range of desired effects, from clinical and rehabilitation goals to the fundamental question of improving the quality of life for people with these disorders.
Improving organization and financing of services. Public mental health and other necessary services may be delivered through a confusing maze of bureaucracies. Finding ways to deliver comprehensive, community-based services in an efficient, equitable way, to guarantee access to all who need them with proper concern for dignity and personal needs and desires, is a challenge. Finding ways to provide the needed services economically, assuring that money invested is well spent, and providing adequate financing, is another. The proper role of the judicial and correctional system in providing care to mentally ill offenders and the best uses of coercive treatments, such as outpatient services, are specific areas of interest in the law and mental health. Strategies for overcoming the terrible stigma accompanying these disorders also need to be tested and applied.
Identifying research strategies and issues. The Report has identified a number of ways that research capacity can be developed, including efforts to increase research training. One important need is to enhance the use of research demonstrations, especially controlled, multi-site demonstration projects such as are used in other fields of health care. Another area of the highest priority is to find better ways to apply the results of research, and we are establishing a Task Force on Knowledge Exchange to conduct this effort.
Question. Please provide an update on your implementation of the National Plan for Research on Child and Adolescent Mental Disorders.
Answer. Specific action steps are being taken for the implementation of the National Plan. In order to more accurately determine the incidence, prevalence, and range of child and adolescent mental disorders, & multisite methodologic study is in progress that is providing information on how best to implement a nation-wide epidemiologic survey. Information from this current study will form the basis of a much larger, developmental epidemiologic survey of child and adolescent mental disorders, envisioned to begin' in 1994. NIMH has also begun steps to initiate a multicenter collaborative treatment study of disruptive behavior disorders and attention deficit hyperactivity disorder, one of the most common and disabling childhood mental disorders. The determination of effective treatments and service systems for these children and adolescents will have important longer-term effects for a substantial portion of children who are under-, ineffectively, or untreated and who may go on to develop significant problems with substance abuse, delinquency, or adult vocational disability.
NIMH is currently preparing to release a major new Program Announcement to coordinate and link efforts to develop the child and adolescent disorders research areas entitled, Implementation of the National Plan for Research on Child and Adolescent Mental Disorders. Additional activities in this coming year include a workshop to teach young or prospective investigators how to submit grants, a meeting of journal editors who impact on this field, and a conference cosponsored with other Federal funding agencies and private foundations to stimulate cooperation between Federal and private sources of funding.
Question. How do these two new research plans interface with the your ongoing blueprints for the Decade of the Brain and Schizophrenia research?
Answer. These two new research plans Interface in numerous ways with The National Plan for Research on Schizophrenia and the Brain (combining the Decade of the Brain and Schizophrenia Plans) and The National Plan for Child and Adolescent Mental Disorders. These Initiatives complement one another and take advantage of the process and content involved in the development of each.
The interface of the child and adolescent research blueprint and the Decade of the Brain plan is significant because the Decade of the Brain plan includes no specific plans for research on development and maturation of the brain, studies which may lead to the understanding of the etiology of mental illnesses in the early period of life. Research on the complex origins of child and adolescent mental disorders--particularly studies focusing on developmental neurobiology and the genetic control of nervous system development-is likely to clarify the biological foundations of many mental disorders that primarily affect adults, including schizophrenia. Efforts at early detection and treatment of psychopathology in young children, especially through longitudinal studies, may reveal risk factors for and predictors of disorders such as schizophrenia prior to the onset of clinical illness.
Conversely, research focused on the neuroscience of mental disorders has practical application for disorders affecting all ages and understanding the causes and treatment of disorders found primarily among adults will provide invaluable fundamental insights, technological advances, and treatment approaches that can be applied to research and clinical care with younger populations. Thus, we expect these ma jor NIMH research initiatives to have synergistic effects in attracting talented researchers to the mental health field and in stimulating new ways to understand and overcome mental disorders in people of all ages.
Improvement in services for the severely mentally 111 may be dependent on new findings in basic or clinic research. Basic research interacts directly with clinical research and vice versa. The indirect impact of the decade of Brain plan and the Child and Adolescent Plan on the service plan is through clinical research findings, based on basic research findings translated into better treatment for mental illnesses. Although The National Plan of Research to Improve Care for Severe Mental Disorders was developed as a direct extension of the National Plan for Schizophrenia Research, the research results and services improvements it promises will also be applied to children and adolescents where appropriate. The National Advisory Mental Health Council systematically reviewed the state of knowledge and formulated recommendations to build the services research field. The recommendations of The National Plan of Research to Improve Care for Severe Mental Disorders will build on the base of research in basic and clinical research laid out in the earlier plans, and extend them in the area of finding better ways to deliver needed mental health services.
HEALTH RESOURCES AND SERVICES ADMINISTRATION
STATEMENT OF DR. ROBERT G. HARMON, DIRECTOR
ATIONS AND MANAGEMENT
RESOURCES DEVELOPMENT DR. FITZHUGH S.M. MULLAN, BUREAU OF HEALTH PROFESSIONS DR. MARILYN GASTON, DIRECTOR, BUREAU OF HEALTH CARE DE
LIVERY AND ASSISTANCE DR. VINCE L. HUTCHINS, ACTING DIRECTOR, MATERNAL AND
CHILD HEALTH BUREAU DENNIS WILLIAMS, DEPUTY ASSISTANT SECRETARY, BUDGET, OF. FICE OF THE SECRETARY, DEPARTMENT OF HEALTH AND HUMAN SERVICES
BUDGET REQUEST Senator HARKIN. Our next witness is Dr. Robert Harmon, the Administrator of the Health Resources and Services Administration.
Dr. Harmon makes his second appearance before the subcommittee today to testify on the budget proposal for HRSA in fiscal year 1992. The administration requested $2.025 billion for HRSA programs, about $72 million less than in fiscal year 1991. The budget includes some funding increases for essential priorities such as reducing infant mortality. However, no funds or major cuts are proposed for other important priorities such as training doctors, nurses, and other health professionals.
AIDŚ programs would be level-funded in fiscal year 1992. This is disturbing, giving that AIDS cases continue to mount, as does the evidence that early intervention and treatment is critical. I am concerned that all the funds proposed for the healthy start infant mortality initiative in fiscal year 1991, and some from fiscal year 1992, would come from other maternal and child health programs. As I said earlier today, I simply cannot support that.
It is equally troubling to note that only some major urban areas appear to merit the attention, while no funds are proposed for the rural health outreach grants program to assure a healthy start to Americans living in the smaller communities and more rural areas of America.
I believe we need to take a comprehensive, national approach to reducing infant mortality, and Dr. Harmon, I want to hear your view of how we might best accomplish that goal. Certainly the Public Health Service has been in the forefront of this effort, and you know that better than I do.