2019 Federal Standard of Excellence
Repurpose for Results
In FY19, did the agency shift funds away from or within any practice, policy, or program that consistently failed to achieve desired outcomes? (Examples: Requiring low-performing grantees to re-compete for funding; removing ineffective interventions from allowable use of grant funds; incentivizing or urging grant applicants to stop using ineffective practices in funding announcements; proposing the elimination of ineffective programs through annual budget requests; incentivizing well-designed trials to fill specific knowledge gaps; supporting low-performing grantees through mentoring, improvement plans, and other forms of assistance; using rigorous evaluation results to shift funds away from a program)
Score
4
4
Administration for Children and Families (HHS)
10.1 Did the agency shift funds/resources away from ineffective practices or interventions used within programs or by grantees?
- Findings from the evaluation of the first round Health Profession Opportunity Grants (HPOG) program influenced the funding opportunity announcement for the second round of HPOG funding. Namely, the scoring criteria used to select HPOG 2.0 grantees incorporated knowledge gained about challenges experienced in the HPOG 1.0 grant program. For example, based on those challenges, applicants were asked to clearly demonstrate—and verify with local employers—an unmet need in their service area for the education and training activities proposed. Applicants were also required to provide projections for the number of individuals expected to begin and complete basic skills education. Grantees must submit semi-annual and annual progress reports to ACF to show their progress in meeting these projections. If they have trouble doing so, grantees are provided with technical assistance to support improvement or are put on a corrective action plan so that ACF can more closely monitor their steps toward improvement.
10.2 Did the agency shift funds/resources away from ineffective policies used within programs or by grantees?
- No examples available.
10.3 Did the agency shift funds/resources away from ineffective grantees?
- In FY12, ACF significantly expanded its accountability provisions with the establishment of the Head Start Designation Renewal System (DRS). The DRS was designed to determine whether Head Start and Early Head Start programs are providing high quality comprehensive services to the children and families in their communities. Where they are not, grantees are denied automatic renewal of their grant and must apply for funding renewal through an open competition process. Those determinations are based on seven conditions, one of which looks at how Head Start classrooms within programs perform on the Classroom Assessment Scoring System (CLASS), an observation-based measure of the quality of teacher-child interactions. Data from ACF’s Head Start Family and Child Experiences Survey (FACES) and Quality Features, Dosage, Thresholds and Child Outcomes (Q-DOT) study were used to craft the regulations that created the DRS and informed key decisions in its implementation. This included where to set minimum thresholds for average CLASS scores, the number of classrooms within programs to be sampled to ensure stable program-level estimates on CLASS, and the number of cycles of CLASS observations to conduct. At the time the DRS notification letters were sent out to grantees in 2011, there were 1,421 non-tribal active grants, and of these, 453 (32%) were required to re-compete (p. 19).
10.4 Did the agency shift funds/resources away from ineffective programs? (e.g., eliminations or legislative language in budget requests)
- No examples available.
10.5 Did the agency shift funds/resources away from consistently ineffective products and services?
- No examples available.
Score
6
6
Administration for Community Living
10.1 Did the agency shift funds/resources away from ineffective practices or interventions used within programs or by grantees?
- ACL uses a quality review system (QRS) for developmental disability programs under ACL’s/Administration for Intellectual and Developmental Disabilities (AIDD). The QRS uses a three-tiered model to review program compliance, outcomes (i.e., evidence), and fiscal operations to review results to target and coordinate technical assistance. The first tier is an annual standardized review. The second tier is standardized, in-depth review involving a team of reviewers. These reviews are conducted on a periodic basis. Tier three is customized monitoring for programs that ACL has significant concerns in terms of compliance and performance. ACL continues development of a formula grant monitoring framework for Older Americans Act Title III and VII state formula grants. The framework combines assessments of grantee’s progress toward program goals and objectives with identification of risk or instances of fraud, waste and abuse. These reviews allow ACL, if warranted, to restrict grant funding based on findings of insufficient evidence of performance.
10.2 Did the agency shift funds/resources away from ineffective policies used within programs or by grantees?
- The Paralysis Resource Center State Pilot Program is part of an effort to ensure program efficiency and to test two approaches for making subawards to community-based organizations that provide long-term services and supports to people with paralysis, their families, and their support networks. Outcomes from the pilot will help ACL assess the most effective and efficient ways to make such subawards and will determine how ACL funds this effort going forward.
10.3 Did the agency shift funds/resources away from ineffective grantees?
- ACL is using a tool developed in FY 2018 to help grant officers more easily monitor the degree to which Chronic Disease Self-Management (CDSME) and Falls Prevention grantees are meeting their ACL approved program completion targets. ACL staff will use this information to either fully release or restrict grant funds over the life of the multi-year awards. Grant scores comprise the following three components:
- Goal 1: Intervention Level – assesses progress towards meeting the target number of program completers (for CDSME grants) or participants (for Falls Prevention grants).
- Goal 2: Sustainability Level – assesses progress towards establishing a sustainable program.
- Grantee Challenges – presents challenges identified by grantees and assesses the strategies proposed to resolve the challenges.
- Combined, these elements provide Project Officers and staff with an overall Grant Score and Status for each grant. The Grant Score provides a numeric indicator of grantee performance. The Grant Status indicates whether the grant is at “Low”, “Medium,” or “High” risk of eventually requiring a no-cost extension, based on the Grant Score. The tool also includes several features for designated administrative users to manage core information pertinent to supporting the manage grantee and grant performance data functionality.
- In addition, the Innovations in Nutrition Programs and Services grants will be monitored using a new tool that enables Project Officers to quickly assess grant status and proactively identify and engage with grantees that would benefit from technical assistance, to ensure that grants are completed on time.
10.4 Did the agency shift funds/resources away from ineffective programs? (e.g., eliminations or legislative language in budget requests)
- While much of ACL’s funding is based on formula grants, and therefore cannot be reallocated to other programs, ACL is working with GSA’s Office of Evaluation Sciences (OES) to test methods for improving outcomes for its congregate meals programs. Under the Older Americans Act, congregate meal sites are required to accept donations from meal recipients. But there has been a concern regarding how to balance the collection of funds that can be used towards meal service and making meal recipients that cannot afford to donate uncomfortable, thus suppressing attendance. This study, being conducted in FY19, will offer concrete evidence to improve program operations.
10.5 Did the agency shift funds/resources away from consistently ineffective products and services?
- While much of ACL’s funding is based on formula grants, and therefore cannot be reallocated to other programs, evaluation staff work closely with program staff to identify ways to translate evaluation findings into technical assistance and other types of program support. For example, based on early results from and evaluation of the Tribal Grant program, ACL has developed new program support materials to improve the delivery of Tribal Caregiver programs.
Score
7
7
U.S. Agency for International Development
10.1 Did the agency shift funds/resources away from ineffective practices or interventions used within programs or by grantees?
- Through the Program Cycle, USAID encourages managing projects and activities adaptively, responding to rigorous data and evidence and shifting design and/or implementation accordingly. For example, USAID’s Lowland Water, Sanitation, and Hygiene (WASH) activity works to accelerate access to improved WASH in three rural lowland regions in Ethiopia. A mid-activity data review highlighted several disappointing results that prompted a program team (USAID/Ethiopia staff and implementing partner) to rethink their approach. The team utilized pause and reflect, strategic collaboration, adaptive management, and monitoring and evaluation for learning. Using this intentional CLA process, the team initiated a virtuous cycle of learning. Soon the team realized that, in these communities dominated by (semi-) pastoralist groups, the operating conditions for effective, sustained behavior change are highly variable. A CLA approach helped the program team define, pivot, and re-design activities that addressed program effectiveness.
10.2 Did the agency shift funds/resources away from ineffective policies used within programs or by grantees?
- In April 2019, USAID released its new Policy Framework which articulates USAID’s approach to providing development and humanitarian assistance and the Agency’s programmatic and operational priorities that follow from it. These priorities and approaches are based on evidence and inform issue-specific development policies, strategies, and vision papers; budget requests and allocations; country and regional strategic plans; good-practice documents and project designs; evaluations and learning agendas; and overall engagement with partners.
- The Framework requires a reorientation of USAID’s programmatic approach to foster self-reliance more effectively. This approach marks a new direction for USAID, but draws on deep experiences and the lessons it has learned. The new approach is grounded in three principles that underpin why it provided assistance to each country, what assistance will be most effective, and how it can ensure the sustainability of its results. These principles are Advance Country Progress, Invest for Impact, and Sustain Results. Ultimately, the framework serves to shift policy to improve program effectiveness in supporting partner countries in their journey to self-reliance.
10.3 Did the agency shift funds/resources away from ineffective grantees?
- USAID shifts funds away from ineffective grantees. For example, the Securing Water for Food Grand Challengeis designed with a Technical Assistance Facility to consult and work with grantees to identify specific growth barriers, and then connect them with vetted service providers that bring expertise and capabilities to help these grantees overcome their strategic barriers. The Technical Assistance Facility provides tailored financial and acceleration support to help these grantees improve their market-driven business development, commercial growth, and scaling.
- If a grantee is unable to meet specific performance targets, such as number of customers or product sales, further funding is not granted and the grantee is re-categorized into the program’s group of unsuccessful alumni. The Securing Water for Food Grand Challenge used milestone-based grants to terminate 15 awards that were not meeting their annual milestones and shifted that money to both grants and technical assistance for the remaining 25 awards in the program.
10.4 Did the agency shift funds/resources away from ineffective programs? (e.g., eliminations or legislative language in budget requests)
- The Agency continuously works to improve upon its programming based on the best-available evidence. In one example, the findings of a mid-term evaluation of Reproductive, Maternal, Neonatal, Child, and Adolescent Health (RMNCH+A) activities resulted in shifting resources towards a more effective implementation of the interventions. Taking lessons from the first phase of the project, and based on the evaluation recommendation, the project decided to focus on limited technical areas where activities have sufficient feedback loops and opportunities for learning and continuous improvements. For example, the project will continue to cover maternal, newborn, and child health areas, but the adolescent health interventions will be done through other USAID funded projects.
10.5 Did the agency shift funds/resources away from consistently ineffective products and services?
- USAID uses rigorous evaluations to maximize its investments. A recent independent study found that 71 percent of USAID evaluations have been used to modify and/or design USAID projects. Below are some examples where USAID has shifted funds and/or programming decisions based on performance:
- An evaluation of an education project in El Salvador revealed the need to improve effectiveness by better matching interventions with individual target school and community needs to serve out-of-school youth. As a result, the project changed how it is working with the Ministry of Education.
- USAID Acceleration programs use a pilot and pivot approach to test out different services and vendors to help its innovators accelerate their work. These services and vendors are held to high customer satisfaction minimums, if the vendors are not constantly scoring a 90/100 or higher they are removed from the service offering.
- USAID’s INVEST program is designed for constant feedback loops around the partner performance. Not only are under-performing partners dropped, but new partners can be added dynamically, based on demand. This greatly increases USAID’s new partner base and increases the performance standard across the board.
Score
3
3
Corporation for National and Community Service
10.1 Did the agency shift funds/resources away from ineffective practices or interventions used within programs or by grantees?
- No examples available.
10.2 Did the agency shift funds/resources away from ineffective policies used within programs or by grantees?
- In recent years, the Senior Corps program has invested over $1 million in various management analyses that are informing operations, programming, and its research agenda moving forward. Information was used to revise policies and regulations in FY19 by allowing grantees more flexibility in how they allocate their funds to programming that shifts resources from administrative activities to activities that directly serve communities.
10.3 Did the agency shift funds/resources away from ineffective grantees?
- AmeriCorps State and National will reallocate $500,000 to provide intensive technical assistance to grantees with insufficient evidence. Special conditions were placed on these grants so that funding is contingent on grantees engaging in evaluation capacity building activities. This will provide additional training and technical assistance to move grantees with preliminary evidence along the evidence continuum. Specifically, this technical assistance is designed to increase the evidence base for these grantees through coaching and technical assistance from NORC at the University of Chicago. If grantees fail to move along the continuum when they recompete for funding they will either receive less money or no funding depending on the reasons for the evidence stagnation.
10.4 Did the agency shift funds/resources away from ineffective programs? (e.g., eliminations or legislative language in budget requests)
- No examples available.
10.5 Did the agency shift funds/resources away from consistently ineffective products and services?
- CNCS began migrating to shared services in August 2019. This decision was made in alignment with Goal One of the agency’s Transformation and Sustainability plan (Strengthen core business functions). The agency made this decision to achieve: improved accountability in internal business practices; increased capacity across operational areas and better support for the work of CNCS awardees; and improved core operational functions to provide a stronger foundation for increasing national service impact across the country. CNCS has entered into an interagency agreement with the Department of Treasury’s Administrative Resource Center (ARC) to shift some procurement, accounting, and human capital processes to ARC’s shared services environment.
Score
6
6
U.S. Department of Education
10.1 Did the agency shift funds/resources away from ineffective practices or interventions used within programs or by grantees?
- ED uses evidence in competitive programs to encourage the field to shift away from less effective practices and toward more effective practices. For example, the Education Innovation and Research (EIR) program supports the creation, development, implementation, replication, and scaling up of evidence-based, field-initiated innovations designed to improve student achievement and attainment for high-need students. IES released The Investing in Innovation Fund: Summary of 67 Evaluations, which can be used to inform efforts to move to more effective practices. The Department is exploring the results to determine what lessons learned can be applied to other programs.
10.2 Did the agency shift funds/resources away from ineffective policies used within programs or by grantees?
- In 2015, Congress included a new provision in ESEA, limiting school districts receiving Title II-A funds (Supporting Effective Instruction) to reducing class size to a level that is evidence-based, to the extent evidence is available, based in part on past research findings that indicated class-size reduction is most effective for low-income students in early grades.
10.3 Did the agency shift funds/resources away from ineffective grantees?
- Program officers review discretionary grantees annually to determine whether they are making substantial progress. If a grantee has not made substantial progress, the Department may reduce an award in a subsequent year or decline to continue funding the grantee.
- ED is implementing a number of Pay for Success projects which seek to shift resources away from grantees that fail to meet project goals:
- Career and Technical Education (CTE): $2 million to support the development of PFS projects to implement new or scale up existing high-quality CTE opportunities.
- Early Learning: $3 million for Preschool Pay for Success feasibility pilots to support innovative funding strategies to expand preschool and improve educational outcomes for 3- and 4- year-olds. These grants are allowing states, school districts, and other local government agencies to explore whether Pay for Success is a viable financing mechanism for expanding and improving preschool in their communities.
- ED seeks to shift program funds to support more effective practices by prioritizing the use of evidence as a requirement when applying for a competitive grant. For ED’s grant competitions where there is data about current or past grantees, or where new evidence has emerged independent of grantee activities, ED typically reviews such data to shape the design of future grant competitions.
10.4 Did the agency shift funds/resources away from ineffective programs? (e.g., eliminations or legislative language in budget requests)
- The President’s FY20 Budget eliminates, streamlines or reduces 39 discretionary programs that duplicate other programs, are ineffective, or are supported with state, local, or private funds. Major eliminations and reductions in the FY20 Budget proposal include:
- Supporting Effective Instruction State grants (Title II-A), a savings of $2.1 billion. The program is proposed for elimination because the program lacks evidence of improving student outcomes (see pp. C-16 to C-19 of the FY20 budget request). It also duplicates other ESEA program funds that may be used for professional development.
- 21st Century Community Learning Centers program, a savings of $1.2 billion. The program lacks strong evidence of meeting its objectives, such as improving student achievement. Based on program performance data from the 2014-2015 school year, more than half of program participants had no improvement in their math and English grades and nearly 60% of participants attended centers for fewer than 30 days (see pp. C-21 to C-26 in the FY20 budget request).
- In the previous administration, ED worked with Congress to eliminate 50 programs, saving more than $1.2 billion, including programs like Even Start (see pp. A-72-73) (-$66.5 million in FY11) and Mentoring Grants (see p. G-31) (-$47.3 million in FY10), which the Department recommended eliminating out of concern based on evidence.
10.5 Did the agency shift funds/resources away from consistently ineffective products and services?
- As noted earlier, program officers review discretionary grantees annually to determine whether they are making substantial progress. If a grantee has not made substantial progress, the Department may reduce an award in a subsequent year or decline to continue funding the grantee.
Score
8
8
U.S. Dept. of Housing & Urban Development
10.1 Did the agency shift funds/resources away from ineffective practices or interventions used within programs or by grantees?
- In recent years HUD has reduced the role of transitional housing in favor of rapid re-housing as a cost-effective alternative for families experiencing homelessness that have low barriers and can benefit from shorter interventions.
- CDBG-DR (Disaster Recovery) is a large and growing program funded by emergency appropriations outside of HUD’s regular budgeting process. In FY 2018, HUD started promoting mitigation activities for disaster-prone communities, allocating $16 billion of the $28 billion in emergency disaster recovery funds for disaster mitigation in previously disaster-stricken communities. By investing in mitigation activities, rather than paying to rebuild existing infrastructure in its previous form, HUD shifted funds in order to help to break the cycle of publicly-funded rebuilding and repeated loss.
10.2 Did the agency shift funds/resources away from ineffective policies used within programs or by grantees?
- Evaluation of the Housing First model of rehousing chronically homeless individuals with serious mental illness supported a policy shift toward first achieving housing stability to provide a platform for social services. Based on such evidence, HUD continues to encourage the use of more cost-effective rapid rehousing approaches combined with increased permanent supportive housing that is integrated with mainstream services provided by HHS, VA, and others.
10.3 Did the agency shift funds/resources away from ineffective grantees?
- HUD grant programs typically provide for recapture of funds that are not committed in a timely fashion, or that remain unexpended after the limits. Effective management by grantees can be especially crucial for timely completion of complex housing development projects, such as with the Capital Fund for public housing and Housing Trust Fund for states. Such funds are reallocated to more effective grantees.
- Preference points used by competitive programs favor grantees that provide evidence of successful outcomes and strategies. The Continuum of Care program awards points that shift funds toward grant applications that have demonstrated better outcomes, that rank and fund better-performing projects, and that take over programs from small and struggling recipients. As noted in the notice of funding: “To encourage CoC mergers and mitigate the potential adverse scoring implications that may occur when a high performing CoC merges with one or more lower performing CoC(s), HUD will award up to 25 bonus points to CoCs that completed a merger…”
10.4 Did the agency shift funds/resources away from ineffective programs? (e.g., eliminations or legislative language in budget requests)
- No examples available.
10.5 Did the agency shift funds/resources away from consistently ineffective products and services?
- No examples available.
Score
6
6
U.S. Department of Labor
10.1 Did the agency shift funds/resources away from ineffective practices or interventions used within programs or by grantees?
- DOL has made targeted investments in evidence-based programs to help workers remain competitive and gain access to family sustaining jobs by focusing on its highest priority functions and disinvesting in programs that are duplicative, unproven, non-essential, or ineffective. The reform of the Trade Adjustment Assistance (TAA)program is an example of such efforts. A 2012 evaluation of TAA found that only 37% of participants became employed in the occupations for which they received training. DOL’s FY20 budget request refocuses TAA on apprenticeship and other work-based job training to ensure that participants are preparing for in-demand jobs and industries.
10.2 Did the agency shift funds/resources away from ineffective policies used within programs or by grantees?
- Reforming Job Corps provides an example of such efforts to repurpose resources based upon a rigorous analysis of available data. As part of this reform effort, DOL’s FY20 budget request ends the Department of Agriculture’s (USDA) involvement in the program, unifying responsibility in DOL. Workforce development is not a core USDA role, and the 25 centers it operates are overrepresented in the lowest performing cohort of centers.
10.3 Did the agency shift funds/resources away from ineffective grantees?
- The Employment & Training Administration’s (ETA) prospective YouthBuild and Job Corps grant applicants are selected, in part, based on their past performance. These programs consider the entity’s past performance of demonstrated effectiveness in achieving critical outcomes for youth. For the Job Corps reform, the Department’s FY20 budget request also proposes new legislative flexibilities that would enable the Department to more expediently close low-performing centers, target the program to groups more likely to benefit, and make the necessary capital investments to ensure successful pilot programs. These reforms would save money and improve results by eliminating ineffective centers and finding better ways to educate and provide skills instruction to youth.
10.4 Did the agency shift funds/resources away from ineffective programs? (e.g., eliminations or legislative language in budget requests)
- DOL’s FY20 budget request eliminates funding for the Senior Community Service Employment Program(SCSEP). SCSEP has a goal of transitioning half of participants into unsubsidized employment within the first quarter after exiting the program, but has struggled to achieve even this modest goal.
10.5 Did the agency shift funds/resources away from consistently ineffective products and services?
- A rigorous 2012 evaluation of the Trade Readjustment Assistance (TAA) Program demonstrated that workers who participated in the program had lower earnings than the comparison group at the end of a four-year follow-up period, in part because they were more likely to participate in long-term job training programs rather than immediately reentering the workforce. However, this training was not targeted to in-demand industries and occupations, and, as found in Mathematica’s evaluation of the TAA program, only 37% of participants became employed in the occupations for which they trained. In the FY20 budget request, the Department addresses these issues by continuing to propose reauthorization of the TAA Program that refocuses TAA on apprenticeship and on-the-job skills development strategies, ensuring participants are learning skills for in-demand occupations.
Score
6
6
Millennium Challenge Corporation
10.1 Did the agency shift funds/resources away from ineffective practices or interventions used within programs or by grantees?
- In a number of cases, MCC has repurposed investments based on real-time evidence. In MCC’s first compact with Lesotho, MCC cancelled the Automated Clearing House Sub-Activity within the Private Sector Development Project after monitoring data determined that it would not accomplish the economic growth and poverty reduction outcomes envisioned during compact development. The remaining $600,000 in the sub-activity was transferred to the Debit Smart Card Sub-Activity, which targeted expanding financial services to people living in remote areas of Lesotho. In Tanzania, the $32 million Non-Revenue Water Activity was re-scoped after the final design estimates on two of the activity’s infrastructure investments indicated higher costs that would significantly impact their economic rates of return. As a result, $13.2 million was reallocated to the Lower Ruvu Plant Expansion Activity, $9.6 million to the Morogoro Water Supply Activity, and $400,000 for other environmental and social activities. In all of these country examples, the funding is either reallocated to activities with continued evidence of results or returned to MCC for investment in future programming.
10.2 Did the agency shift funds/resources away from ineffective policies used within programs or by grantees?
- MCC also consistently monitors the progress of compact programs and their evaluations across sectors, using the learning from this evidence to make changes to MCC’s operations. For example, as part of MCC’s Principles into Practice initiative, in November 2017 MCC undertook a review of its portfolio investments in roads in an attempt to better design, implement, and evaluate road investments. Through evidence collected across 16 countries with road projects, MCC uncovered seven key lessons including the need to prioritize and select projects based on a road network analysis, to standardize content and quality of road data collection across road projects, and to consider cost and the potential for learning in determining how road projects are evaluated. In FY19, the lessons from this analysis are being applied to road projects in compacts in Côte d’Ivoire and Nepal as MCC roads investments see a shift toward increased maintenance investments. Critically, the evidence also pointed to MCC shifting how it undertakes road evaluations which led to a new request and re-bid for proposals for MCC’s roads evaluations based on new guidelines and principles.
10.3 Did the agency shift funds/resources away from ineffective grantees?
- MCC has established a Policy on Suspension and Termination that lays out the reasons for which MCC may suspend or terminate assistance to partner countries, including if a country “engages in a pattern of actions inconsistent with the MCC’s eligibility criteria,” by failing to achieve desired outcomes such as:
- A decline in performance on the indicators used to determine eligibility;
- A decline in performance not yet reflected in the indicators used to determine eligibility; or
- Actions by the country which are determined to be contrary to sound performance in the areas assessed for eligibility for assistance, and which together evidence an overall decline in the country’s commitment to the eligibility criteria.
- Of the compacts that have been selected by MCC’s Board of Directors, 12 have had their partnerships ended due to concerns about country commitment to MCC’s eligibility criteria. MCC’s Policy on Suspension and Termination also allows MCC to reinstate eligibility when countries demonstrate a clear policy reversal, a remediation of MCC’s concerns, and an obvious commitment to MCC’s eligibility indicators, including achieving desired results. For example, in March 2012, MCC suspended Malawi’s compact prior to Entry into Force as MCC determined that the Government of Malawi had engaged in a pattern of actions inconsistent with MCC’s eligibility criteria. Thereafter, the new Government of Malawi took a number of decisive steps to improve the democratic rights environment and reverse the negative economic policy trends of concern to MCC, which led to a reinstatement of eligibility for assistance in June 2012.
10.4 Did the agency shift funds/resources away from ineffective programs? (e.g., eliminations or legislative language in budget requests)
- MCC essentially operates only two programs, compact and threshold, which are so tied to core service delivery that they could not be eliminated as such.
10.5 Did the agency shift funds/resources away from consistently ineffective products and services?
- No examples available.
Score
4
4
Substance Abuse and Mental Health Services Administration
10.1 Did the agency shift funds/resources away from ineffective practices or interventions used within programs or by grantees?
- The State Opioid Response Grants program required states and subgrantees to only use evidence-based treatments, practices, and interventions. As such, SAMHSA disallowed the use of medical withdrawal (detoxification) in isolation since it “is not the standard of care for OUD, is associated with a very high relapse rate, and significantly increases an individual’s risk for opioid overdose and death if opioid use is resumed” (p. 6). And SAMHSA clarified: “SAMHSA will monitor use of these funds to assure that they are being used to support evidence-based treatment and recovery supports, and will not permit use of these funds for non-evidence-based approaches” (p. 7). Further, under Standard Funding Restrictions, SAMHSA included: “non-evidence-based treatment approaches” (p. 54).
10.2 Did the agency shift funds/resources away from ineffective policies used within programs or by grantees?
- No examples available.
10.3 Did the agency shift funds/resources away from ineffective grantees?
- No examples available.
10.4 Did the agency shift funds/resources away from ineffective programs? (e.g., eliminations or legislative language in budget requests)
- No examples available.
10.5 Did the agency shift funds/resources away from consistently ineffective products and services?
- In January 2018, SAMHSA announced it would shift resources away from the National Registry of Evidence-based Programs and Practices (NREPP) toward targeted technical assistance and training for implementing evidence-based practices. The reasoning was that NREPP had flawed and skewed presentation of evidence-based interventions, which “did not address the spectrum of needs of those living with serious mental illness and substance use disorders.”