Research and Service Programs in the PHS Challenges in Organization (1991) / Chapter Skim
Currently Skimming:
A Brief History of ADAMHA and Previous Studies of Its Organization
A Brief History of ADAMHA and Previous Studies of Its Organization
Pages 27-42
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From page 27... ...
In recent years, Congress has reversed its policy focus: 1981 block grant legislation put the administration of service-funding program into ADAMETA's central office; but since 1986, appropriations for service-related programs and demonstrations have shifted responsibility back to the institutes, as well as giving rise to two new offices within ADAMElA, the Office for Substance Abuse Prevention and the Office for Treatment Improvement.
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From page 28... ...
To some extent, however, the research portfolio of the NIMH differed from other NIH institutes. In addition to basic and clinical biomedical research, NIMH strongly supported behavioral research and some social science research.
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From page 29... ...
Defending the threefold mission of NIMH, he rev rote to the Surgeon General: An analysis on a point by point basis shows the disastrous results of this dismemberment of a presently integrated approach to a major health problem that appears to require, even more than other areas, integration of effort in all areas of approach: research, training, service, control.6 THE 1960s During the 1960s, congressional interest in mental health shifted toward an even greater emphasis on service development. Congress enacted grant programs to improve state hospitals, to establish community-based psychiatric treatment, and to develop separate community-based treatment centers for alcoholism and drug abuse.
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From page 30... ...
Attempts to link alcohol and mental health treatment facilities date from this period, when amendments to the Comprehensive Mental Health Centers Act in 1968 provided for construction of alcoholic treatment facilities, to be operated in conjunction with CMHCs. By 1967, the budget for the CMHC program exceeded the entire NIMH research budget.
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From page 31... ...
The Nixon administration was not enthusiastic about federal support for service and health manpower programs, nor did it support the behavioral and social research thrust of the 1960s. Seeking to limit the federal role in the direct provision of services, the administration moved to break apart HSMHA and to allow the authorities for "unnecessary categorical" programs (including those for drug abuse, alcoholism, and community mental health centers)
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From page 32... ...
Yet despite the fact that PHS, except for NIMH, was organized functionally (i.e., research at NIH, prevention at the Centers for Disease Control, clinical training at the Health Resources Administration, and service delivery at the Health Services Administration) , the task force concluded that the continuing social stigma attached to the ADM disorders precluded their integration into the general health agencies of that time.
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From page 33... ...
HISTORY OF ADAMHA 33 ~ FIGURE 2-1~ Or~anlzational Options The Gardner Realist :..
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From page 34... ...
In 19~31, the categorical and formula grant program at all three institutes, including most ADM services activities, were combined into a single Alcohol, Drug Abuse, and Mental Health (ADMS) block grant to the states.
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From page 35... ...
The change to the block grant program also coincided with the implementation of the 1981 Office of Management and Budget Paperwork Reduction Act, which severely limited the authority of federal agencies to collect data and standardize report formats on state-administered federal programs. Many in the research community supported the removal of services responsibilities from the ADAMHA institutes, the renewed focus on biomedical research, and the appointment of scientists to top-level agency positions.
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From page 36... ...
The "Lewin Report," submitted in Janualy 1988, identified five organizational options (Figure 2-2~.~3 The interview results showed no strong preference for or against changing the organizational structure of ADAMHA, although choices of respondents split along interest areas (i.e., biomedical researchers, state officials, and service providers chose options consistent with others in their interest area)
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From page 38... ...
Respondents identified the consolidation of ADM services programs under the 1981 block grant legislation as a contributing factor. In addition, some respondents reported that
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From page 39... ...
Consolidation of ADM services under the block grant program eliminated federally directed services programs' yet the states and service providers continue to look to ADAMHA and expect the agency to play a strong role in mental health services research, policy direction, and advocacy in the ADM fields. It remains unclear, however, if the institutes should be expected to take an advocacy role on policy issues or if this role should be assumed elsewhere in the federal government.
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From page 40... ...
It also authorized for the first time a federal set-aside from the ADMS block grant program, to be used by ADAMHA to conduct services demonstrations and health services research, to collect data, and to provide technical assistance to the states. The 1988 legislation resulted in the administrative creation of the Office for Treatment Improvement (OTI)
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From page 41... ...
S Hanft, "The Changing Relationship of the National Institutes of Health and the Alcohol, Drug Abuse, and Mental Health Administration," paper prepared for the IOM Committee on Co-Administration of Service and Research Programs of the NIH, ADAMHA, and Related Agencies, 1991; available from the National Technical Information Services, Springfield, Va.;*
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