For other versions of this document, see http://wikileaks.org/wiki/CRS-RL33997 ------------------------------------------------------------------------------ £ ¢ ¢ Prepared for Members and Committees of Congress ¢ SAMHSA is the federal agency that provides federal funds for community-based substance abuse and mental health services. SAMHSA awards discretionary funds to substance abuse and mental health programs through its authorities in Title V of the Public Health Service (PHS) Act. In addition, SAMHSA provides formula-based Substance Abuse Prevention and Treatment (SAPT) block grants and Mental Health (MH) block grants through its authorities in Title XIX of the PHS Act. SAMHSA has had level funding at approximately $3 billion since it was last reauthorized in 2000. Most of SAMHSA's authorities expired at the end of FY2003. The 2000 reauthorization (P.L. 106-310) focused on improving mental health and substance abuse services for children and adolescents, implementing proposals to give states more flexibility in the use of block grant funds with accountability based on performance, and consolidating discretionary grant authorities to give the Secretary of the Department of Health and Human Services (HHS) more flexibility to respond to those who require mental health and substance abuse services. The legislation provided a waiver from the requirements of the Narcotic Addict Treatment Act of 1974 to permit qualified physicians to dispense schedule III, IV, or V narcotic drugs or combinations of such drugs approved by Food and Drug Administration (FDA) for the treatment of heroin addiction, and provided a comprehensive strategy to combat methamphetamine use. SAMHSA has had three new authorizations since 2000. The Sober Truth on Preventing Underage Drinking Act of 2005 (P.L. 109-422) requires SAMHSA to collaborate with other federal agencies to prevent alcohol use by minors. The Garrett Lee Smith Memorial Act of 2004 (P.L. 108-355) enables SAMHSA to support youth suicide prevention activities in states and on college campuses. The No Child Left Behind Act of 2002 (P.L. 107-110) requires SAMHSA to consult with the Secretary of the Department of Education on the soliciting and awarding of grants through this program. As SAMHSA reauthorization is considered, issues that may be of interest include accountability for the block grants, flexibility for SAMHSA to issue grants using its general authority, the Access To Recovery Program, and SAMHSA's role in disaster response. In addition, there have been some criticisms of the formula used to distribute SAMHSA's block grants. This report describes SAMHSA's history, organization, authority, and programs, and analyzes the issues that may be considered if the 110th Congress takes up the agency's reauthorization. The Appendixes include a list of relevant websites, the National Outcome Measures, and a table that shows authority and appropriations for SAMHSA's various programs since 2004. Background and History.................................................................................................................. 1 Organization and Funding ............................................................................................................... 2 Center for Mental Health Services (CMHS) ............................................................................. 2 Center for Substance Abuse Treatment (CSAT)........................................................................ 2 Center for Substance Abuse Prevention (CSAP) ...................................................................... 2 Priorities Matrix ........................................................................................................................ 4 Reauthorization Issues in 2000........................................................................................................ 4 Authorizations Since FY2000 ......................................................................................................... 5 The Sober Truth on Preventing Underage Drinking Act of 2005.............................................. 5 The Garrett Lee Smith Memorial Act of 2004 .......................................................................... 6 The No Child Left Behind Act of 2002..................................................................................... 6 Current Reauthorization Issues........................................................................................................ 6 Accountability for SAMHSA Grants ........................................................................................ 6 Flexible Use of Funds ............................................................................................................... 6 Access To Recovery (ATR)....................................................................................................... 7 Disaster Response ..................................................................................................................... 7 Collaboration with Other Federal Agencies .............................................................................. 7 Focus on Prevention and Early Intervention ............................................................................. 8 Block Grants Formula ............................................................................................................... 8 History ................................................................................................................................ 8 Current Formula.................................................................................................................. 9 Issues Regarding Current Formula ................................................................................... 10 Figure 1. SAMHSA Funding FY2000-FY2007 .............................................................................. 3 Table 1. SAMHSA Funding, FY2000-FY2008 ............................................................................... 3 ¡ Appendix A. Program Descriptions for Authorized SAMHSA Sections .......................................11 Appendix B. SAMHSA Authorization and Appropriation Levels (FY2004-FY2008) ................ 14 Appendix C. SAMHSA Matrix of Priorities ................................................................................. 18 Appendix D. SAMHSA National Outcome Measures .................................................................. 19 Appendix E. Useful SAMHSA Resources .................................................................................... 20 Author Contact Information .......................................................................................................... 20 ¢ The Substance Abuse and Mental Health Services Administration (SAMHSA) is the federal agency, located within the Department of Health and Human Services (HHS), that funds mental health and substance abuse treatment and prevention services. SAMHSA provides federal support for these services by administering two block grants (one for substance abuse prevention and treatment services, the other for mental health services), two other formula grants, and discretionary grants to local communities, states, and private entities to address the public health issues of substance abuse and mental illness. SAMHSA funds a wide range of activities including strategic planning, education and training, prevention programs, early intervention, and treatment services. SAMHSA's Substance Abuse Prevention and Treatment (SAPT) block grant provides an average of 42% of the expenses of the state agency responsible for substance abuse. By comparison, SAMHSA's Community Mental Health Services (CMHS) block grant funds only an average of 2-3% of the expenses for the state mental health agency.1 The difference reflects the historical role federal and state governments have played in funding services in these two areas. In 1946 Congress established the National Institute of Mental Health (NIMH), in growing recognition of the extraordinary burden that disorders of brain and behavior place on national health resources. Congress, after determining that a strong program of research and research training would contribute most directly to improving mental health and to treating mental illness, alcoholism, and drug abuse, established NIMH as one of the original components of the National Institutes of Health (NIH). In addition to research, the new institute's mission included programs for educating and training clinical personnel and for providing leadership to enhance the quality of treatment services. In the early 1970s, increasing awareness of the public health problems of alcohol abuse and alcoholism led to the founding of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) from what had been NIMH's alcohol division; a similar event occurred in the field of drug abuse with the founding of the National Institute on Drug Abuse (NIDA). In 1974, the Alcohol, Drug Abuse and Mental Health Administration (ADAMHA) was created as the parent agency for the three research agencies, NIMH, NIAAA and NIDA, and to provide federal funding to states for substance abuse and mental health treatment services. In 1992, the ADAMHA Reorganization Act (P.L. 102-321) moved the three research institutes-- NIMH, NIDA and NIAAA--to NIH. ADAMHA was renamed SAMHSA to reflect its focus on funding community-based services. SAMHSA is authorized under Title V of the Public Health Service (PHS) Act, as amended. The SAPT and CMHS block grants are authorized under the PHS Act Title XIX Part B. In 2000, most of SAMHSA's authorities were reauthorized through FY2003.2 This report describes SAMHSA's history, organization, authority, and programs, and analyzes the issues that may be considered if the 110th Congress takes up the agency's reauthorization. This report will be updated as necessary. 1 SAMHSA, Office of Legislative Affairs, May 7, 2007. 2 P.L. 106-310. £ In FY2008, SAMHSA employed 534 full-time employees and had a budget of nearly $3.4 billion. SAMHSA is composed of three centers of operation, as described below. Each center has a director who reports to SAMHSA's Administrator. Each center has general authority to fund states and communities to address priority substance abuse and mental health needs. This authority, called Programs of Regional and National Significance (PRNS), authorizes SAMHSA to fund projects that (1) translate promising new research findings to community-based prevention and treatment services; (2) provide training and technical assistance; and (3) target resources to increase service capacity where it is most needed. SAMHSA determines its funding priorities in consultation with states and other stakeholders. For a list of specific programs authorities within each of SAMHSA's centers, see Appendix A. CMHS supports mental health services provided by the states and local governments through its mental health block grant and discretionary grant programs. CMHS is authorized to prevent mental illness and promote mental health by providing funds to evaluate, improve and implement effective treatment practices, address violence among children, provide technical assistance to state and local mental health agencies, and collect data. CSAT administers the SAPT block grant and other programs of regional and national significance. CSAT is authorized to develop, evaluate and implement effective treatment programs; and enable improvement of service quality and access. CSAP supports programs of regional and national significance for substance abuse prevention. CSAP is authorized to prevent substance abuse through public education, training, technical assistance, and data collection. This center also provides states with grants to support their strategic planning activities and maintains a registry of evidence-based practices for substance abuse prevention. SAMHSA's budget has been fairly level since the agency was reauthorized in 2000. As shown in Table 1, the dollar amounts have been fairly constant since FY2002. 1 elbaT 8002YF-0002YF ,gnidnuF ASHMAS . )snoill im ni sra llod( 00YF 10YF 20YF 30YF 40YF 50YF 60YF 70YF 80YF SHMC 136 287 238 658 268 109 388 388 119 PASC 974 571 891 791 891 891 291 291 491 TASC 418,1 129,1 610,2 170,2 891,2 791,2 651,2 751,2 951,2 latoT 156,2 669,2 141,3 731,3 332,3 433,3 223,3 623,3 653,3 .snoitacifitsuj tegdub ASHMAS :ecruoS If SAMHSA's appropriation levels are adjusted for inflation, there has been a net decrease in funding available for substance abuse and mental health services. For example, SAMHSA's FY2000 budget of $2.651 billion is equivalent to $3.417 billion for FY2007. Actual FY2007 appropriation was only $3.326 billion. This is illustrated in Figure 1, which shows a downward trend in the real dollar value of SAMHSA's total appropriations between FY2000 and FY2007. Appendix B includes the authorization and appropriation levels for major SAMHSA programs. 7002YF-0002YF gnidnuF ASHMAS .1 erugiF .snoitacifitsuj tegdub ASHMAS gnisu SRC yb deraperP :ecruoS ¡ In April 2006, SAMHSA published a matrix3 that listed the mental health and substance abuse issues addressed by the agency, along with the cross-cutting principles SAMHSA applies to each issue area (See Appendix C). SAMHSA has identified a number of priority areas; typically these are policy issues that cut across the work of its three centers. The priority issue areas include individual health concerns like co-occuring mental health and substance abuse disorders, suicide, behavioral health issues for individuals with hepatitis and HIV/AIDS; societal issues like homelessness, and criminal justice; and systems-level issues like treatment capacity and workforce development. In addition, SAMHSA has identified principles to guide program, policy and resource allocation within the agency. These principles include use of evidence-based practices, evaluation, collaboration, cultural competence, stigma reduction, and cost-effectiveness. The matrix illustrates, for example, that SAMHSA aims to address the issue of co-occurring disorders using each of the cross-cutting principles including evidence-based practices, surveillance, and collaboration. SAMHSA does not formally require its grantees to apply each of these cross-cutting principles to their work. Instead, SAMHSA requires grantees to submit data using the indicators identified through the National Outcome Measures, as described later in this report. There is no crosswalk between the National Outcome Measures and the cross-cutting principles in this matrix. £ SAMHSA was last authorized in 2000, as part of the Children's Health Act.4 At the time of that reauthorization, most of the agency's programs were extended for three years, through FY2003, and the block grant funding formula was not modified. A discussion of issues surrounding the block grant formula, which has not changed since 1992, is presented later in this report. The 2000 reauthorization focused on improving mental health and substance abuse services for children and adolescents, implementing proposals to give states more flexibility in the use of block grant funds, and replacing some existing categorical grant programs with general authority to give the Secretary of HHS more flexibility to respond to those who require mental health and substance abuse services. Provisions in the 2000 reauthorization that related to children and adolescents authorized programs to address emergency response, treatment services, and other comprehensive community-based services for youth at risk due to violence, substance abuse, or mental illness. Other provisions addressed the issue of homeless individuals with substance abuse and/or mental illness. Additionally, SAMHSA was required to issue regulations on use of restraint and seclusion within residential non-medical facilities.5 These facilities were required to report deaths occurring as a result of use of restraint (restricting the movement of a person's limbs, head or body by the use of mechanical or physical devices for the purpose of preventing injury to self or others) and 3 SAMHSA, Matrix of Priorities, April 2006 at http://www.samhsa.gov/Matrix/ Matrix_Brochure_2006.pdf. 4 P.L. 106-310, Titles XXXI - XXXIV. 5 42 CFR 483 Subpart G (2003). seclusion (isolation and containment of residents who pose an imminent threat of physical harm to themselves or others) to the Secretary of HHS within 24 hours of the death. Finally, provisions relating to methamphetamine abuse included criminal penalties, enhanced law enforcement, and programs for abuse prevention and treatment. The 2000 reauthorization legislation also included two additional titles.6 The first title permitted qualified physicians to treat heroin addicts in the doctor's offices using drugs approved by the Food and Drug Administration (FDA), and the second title provided a comprehensive strategy to combat methamphetamine abuse. As part of the 2000 reauthorization, SAMHSA was required to produce two reports to Congress. The first report was on the efforts of the agency and the states to provide coordinated services to individuals who have co-occuring substance abuse and mental health problems. In this report, which was produced in 2002, SAMHSA summarized the prevention and treatment practices for people with co-occurring disorders, and provided a plan for improving services for these people.7 The second report discusses the flexibility and performance of its block grants and accountability measures. This report, which SAMHSA delivered in 2005, detailed the flexibility given to states, defined the common performance measures to be used for state accountability, outlined an implementation strategy, and discussed possible obstacles to implementing the performance measures.8 A discussion of the performance measures is included in this report under the section on current reauthorization issues. £ There have been few modifications of SAMHSA's authority since the 2000 reauthorization. The three major laws passed since then that involve SAMHSA are described below. SAMHSA is required to participate in the Interagency Coordinating Committee on the Prevention of Underage Drinking. The committee is intended to guide policy and program development across the federal government, with respect to underage drinking. SAMHSA has been providing leadership for this committee.10 6 P.L. 106-310, Titles XXXV - XXXVI. 7 SAMHSA, "Report to Congress on the Prevention and Treatment of Co-occurring Substance Abuse Disorders and Mental Disorders," Nov 2002, at http://www.samhsa.gov/reports/congress2002/index.html. 8 SAMHSA, A Report Required by Congress on Performance Partnerships: A Discussion of SAMHSA's Efforts to Increase Accountability Based on Performance in Its Block Grant Programs by Instituting National Outcome Measures, September 2005 at http://www.nationaloutcomemeasures.samhsa.gov/./PDF/performance_partnership.pdf. 9 P.L. 109-422. 10 For a discussion of SAMHSA's role in the prevention of underage drinking, see CRS Report RS22636, Alcohol Use Among Youth, by Andrew Sommers and Ramya Sundararaman. This act authorizes SAMHSA to support the planning, implementation, and evaluation of organized activities involving statewide youth suicide early intervention and prevention strategies; to provide grants to institutions of higher education to reduce student mental and behavioral health problems; to support a national suicide prevention hotline; and to fund a national technical assistance center for suicide prevention. This act requires SAMHSA to provide consultation to the Secretary of Education in awarding grants to local educational agencies for reducing alcohol abuse in secondary schools. £ As SAMHSA reauthorization is considered, issues that may be of interest include accountability for SAMHSA grants, the consequences of increased flexibility for SAMHSA to issue grants using general authority (PRNS), the Access To Recovery Program, and SAMHSA's role in disaster response. ¢ In order to increase accountability, SAMHSA has identified 10 domains as National Outcome Measures (NOMs) in collaboration with the states. The indicators for these domains (see Appendix D) are intended to measure the effectiveness of SAMHSA's mental health and substance abuse grants in enabling individuals in need to attain and sustain recovery; build resilience; and work, learn, and participate fully in their communities. SAMHSA's 2006 annual report indicates that between 43 and 47 states report on the different mental health outcomes, and between 27 and 38 states report on the different substance abuse outcomes.13 ¡ Most of SAMHSA's substance abuse funding is provided under general authority (PRNS), rather than being directed toward specific substances of abuse, whether for prevention or treatment. This gives the agency, in consultation with states, the flexibility to determine the specific problem the funds will be used to address, such as unique or emerging substance abuse issues in a particular state. This practice may also make it easier to provide coordinated care for those in need of multiple substance abuse treatment services. On the other hand, SAMHSA's use its block grant funding and PRNS authority to provide grants makes it difficult for Congress to determine how much funding is used to address specific issues of interest. For example, while there was a line 11 P.L. 108-355. 12 P.L. 107-110, Sec. 4129. 13 SAMHSA, A Message from the Administrator, 2007, at http://www.nationaloutcomemeasures.samhsa.gov/ welcome.asp. The 2006 SAMHSA report highlighting the compiled results of the data submitted by the states is at http://www.nationaloutcomemeasures.samhsa.gov/./PDF/overview2006.pdf. item in SAMHSA's FY2006 budget providing $3.9 million to address methamphetamine abuse, no funding was provided specifically for methamphetamine treatment. However, states used some of their block grant funds, Access To Recovery funds and other grant funds for methamphetamine treatment. For a list of SAMHSA authorizations and their funding levels, see Appendix B. ¢ The Access to Recovery (ATR)14 program is an initiative, proposed by President Bush in FY2003, which provides vouchers to clients for the purchase of substance abuse clinical treatment and recovery support services. The program has been funded at about $98 million per year since FY2004. ATR is different from other grant programs funded by SAMHSA in that the state uses program funds to evaluate the consumer and provide a voucher for the consumer to obtain treatment services from an approved provider of his or her choice. The first ATR grants were funded through CSAT in FY2004. SAMHSA expects to evaluate the program with FY2007 funds, by which time all 15 grantees will have been funded for more than two years. The evaluation is expected to take three years to complete. SAMHSA played a significant role in providing mental health and substance abuse services after Hurricanes Katrina and Rita. However, experts believe that the current evidence base for effective treatment and prevention strategies targeting disaster survivors is weak. One approach to addressing this concern might be requiring a collaborative effort on this issue by SAMHSA and the National Institute of Mental Health (NIMH).15 SAMHSA works closely with the three behavioral health research institutes at NIH (NIDA, NIMH and NIAAA) to enable promising research findings to be translated into services. While SAMHSA has expertise in and funds programs in the fields of substance abuse and mental health, other federal agencies have expertise on and access to populations that are affected by these problems. The Departments of Education and Justice serve youth, with substance abuse and mental health problems, who are also the focus of many SAMHSA programs. The Centers for Disease Control and Prevention's (CDC) Injury Prevention and Control Program works on prevention and surveillance in the fields of violence, suicide and mental health. The Indian Health Service (IHS) serves a population that has significant substance abuse problems, along with issues of access to mental health care. However, there are few statutory requirements by which these agencies are required to work closely with SAMHSA. Improved collaboration between these agencies may be required in order to improve the quality and cost-effectiveness of services provided by the federal government. 14 Program details available at http://atr.samhsa.gov. 15 For a detailed description of the services provided by SAMHSA and analysis of issues, see CRS Report RL33738, Gulf Coast Hurricanes: Addressing Survivors' Mental Health and Substance Abuse Treatment Needs, by Ramya Sundararaman, Sarah A. Lister, and Erin D. Williams. ¢ The 1999 Surgeon General's Report on Mental Health and the 2002 President's New Freedom Commission Report framed mental health as a public health issue. The reports advised applying a public health approach, which would emphasize prevention and early intervention, rather than focusing on individuals who have become severely ill and expensive to treat. The Commission recommended a wholesale transformation of the nation's approach to mental health care involving consumers and providers, policymakers at all levels of government, and both the public and private sectors. SAMHSA has funded states to develop plans to reduce system fragmentation and increase services and support available to people living with mental illness. ¢ The Alcohol, Drug, and Mental Health Services (ADMS) block grant was one of seven block grants established by the Omnibus Budget Reconciliation Act of 1981 (OBRA).16 This block grant consolidated several existing categorical grants for substance abuse and community mental health services in order to provide state and local governments with more flexibility and control over funding to enhance their ability to meet localized needs, to end duplication of effort in delivering services, and to enable better coordination. OBRA authorized ADMS block grant funds for FY1982 through FY1984 in proportion to the historical funding patterns of the original categorical grants. Due to the resulting inequities among states in per capita funding for substance abuse and mental health services, OBRA directed HHS to conduct a study that would produce a formula, considering population and state fiscal capacity, to more equitably distribute funds among states. The 1984 ADAMHA Amendments renewed the block grants for three years with a "minor equity adjustment" that would hold harmless states that would have otherwise received decreased funding under the new calculation.17 Funds above the FY1984 hold-harmless level18 were to be allocated using a formula based equally on state population and relative per capita income. The Amendments also required a non governmental entity to provide recommendations on the formula proposed by HHS. The resulting recommendations, from the Institute for Health and Aging (IHA),19 included phasing out the hold-harmless provisions, allocating funds based on populations at risk, and incorporating a state fiscal capacity measure. The 1988 Anti-Drug Abuse Act20 revised the formula, based on the IHA recommendations, to phase out the hold-harmless provision, use total taxable resources as the measure of state fiscal 16 P.L. 97-35. 17 P.L. 98-509. 18 This hold-harmless provision assured that each state's block grant funding would not be less than the amount it received in FY1984. Currently, the hold-harmless provision is set at the level received by the state in FY1998 for the mental health block grant, and the previous fiscal year for the substance abuse block grant. If there is a decrease in appropriation for the substance abuse block grant, states can get a proportionate decrease in their block grant amount. There is no similar provision for the mental health block grant. 19 IHA is an institute within the University of California, San Francisco. 20 P.L. 100-690, Comprehensive Alcohol Abuse, Drug Abuse and Mental Health Amendments Act. capacity, and incorporate weighted age cohorts as a measure of population at risk. The high-risk age cohorts, determined using an IHA study, were 25-64 years for alcohol abuse, 18-24 years for other drug abuse, and 25-44 for selected mental disorders. Later studies indicated that inequities in the block grants persisted even after the recommendations were implemented.21 The 1992 ADAMHA Reorganization Act split the ADMS block grant into two separate block grants, one for mental health services (CMHS block grant) and another for substance abuse services (SAPT block grant). The formula for the two block grants was adjusted to reflect the differences in the population in need of mental health and substance abuse services.22 The formula for calculating the grant amounts, which is in Sec. 1918 and Sec. 1933 of the PHS Act, takes into account three measures: (1) the population in need of services, (2) costs of services in the state, and (3) fiscal capacity of the state. The first factor is intended to be a proxy for the extent of need for services in a state. Adjustments were made to the weights assigned to each age- cohort in this factor to address the inequities caused by the original weights used. The second factor, which is the cost of services, is derived from the 1990 report of Health and Economics Research, Inc., and ranges from 0.9 to 1.1.23 The third factor, which is the fiscal capacity of the state, is intended to adjust for differences in state capacity to pay for these services. This factor uses the three-year mean of the total taxable revenue of the state. The three factors mentioned above are multiplied to produce a score for the state. To calculate the grant amount for a given state, that state's score is mutiplied by the total available grant amount and divided by the sum of all the states' (and District of Columbia's) scores. The formula can be written as: Gi = A ( Xi / Xi) where Gi = grant amount for the ith state A = total funds appropriated for distribution among the states Xi = score for the ith state There is a hold-harmless provision (no less than previous year's amount) as well as a state minimum provision ($50,000 + 30.65% of the percentage increase in the total block grant amount). 21 General Accounting Office (now Government Accountability Office), T-HRD-91-38, Substance Abuse Funding: Not Justified by Urban-Rural Differences in Need, 1991. 22 General Accounting Office (now Government Accountability Office), T-HRD-91-32, Mental Health Grants: Funding Not Distributed in Accordance with State Needs, 1991. 23 Burnam et al., Review and Evaluation of Substance Abuse and Mental Health Services Block Grant Allotment Formula, RAND Corporation, 1997. A number of issues has been raised regarding the current formula. First, the formula does not consider variations in numbers of uninsured individuals across the states, and other federal funding (e.g., Medicare and Medicaid) that a state may also receive for mental health and substance abuse services. Second, experts recommend using data from major national epidemiological datasets to determine the population in need of services. These datasets are from the National Comorbidity Survey-Replication24 for mental health needs, and the National Survey on Drug Use and Health (NSDUH)25 for substance abuse needs. Third, research indicates that the currently used cost-of-services measure does not adequately represent interstate wage variations in occupations related to substance abuse and mental health.26 24 SAMHSA, The National Comorbidity Survey (NCS-1) studied the prevalence and correlates of mental disorders from 1990 to 1992. The NCS Replication (NCS-R) was carried out with a new national sample from 2001 to 2003 to study trends in a wide range of variables assessed in the baseline NCS-1. 25 SAMHSA, NSDUH, which was formerly known as the National Household Survey on Drug Abuse (NHSDA), is designed to produce drug and alcohol use incidence and prevalence estimates and report the consequences and patterns of use and abuse in the general U.S. civilian population aged 12 and older. 26 Burnam et al., Review and Evaluation of Substance Abuse and Mental Health Services Block Grant Allotment Formula, RAND Corporation, 1997. )dednuf toN( .stcefed emordnyS )c52-bb092(C915 .ceS htrib detaler-lohocla ro emordnys lohocla latef htiw desongaid slaudividni ot secivres edivorp oT lohoclA lateF htiw slaudividnI rof secivreS )dednuf toN( .esu lohocla egarednu tneverp ot smargorp tuo yrrac dna snalp poleved ot stnarG gniknirD egarednU ecudeR ot smargorP )b52-bb092( B915 .ceS )dednuf toN( .seitinummoc rieht dna seilimaf ksir seilimaF gninehtgnertS rof stnarG )a52-bb092( A915 .ceS -gih fo slaudividni rof secivres noitneverp esuba ecnatsbus dna noitnevretni ylrae edivorp ot stnarG )dednuf toN( .sresuba ecnatsbus fo nerdlihc ot slarrefer dna tnemtaert ,snoitaulave edivorp ot stnarG sresubA ecnatsbuS fo nerdlihC rof secivreS )52bb-092( 915 .ceS .stroffe noitneverp esuba ecnatsbus yrassecen rof edivorp ecnacifingiS lanoitaN dna lanoigeR fo sdeeN ot seititne lacol dna setats fo yticapac esaercni dna ,ecnatsissa lacinhcet dna gniniart edivorp ,secitcarp dna noitneverP esubA ecnatsbuS fo ytiroirP )22-bb092( 615 .ceS tseb no egdelwonk esaercni ot dednetni seitivitca dnuf dna stnarg edivorp ot ytirohtua lareneG )PASC( noitneverP esubA ecnatsbuS rof retneC .esuba ecnatsbus stnarG kcolB pihsrentraP ecnamrofreP )53-x002( )a( 5391 .ceS taert dna tneverp ot seitivitca etaulave dna ,tuo yrrac ,nalp ot alumrof yb setatS ot gnidnuf sedivorP tnemtaerT dna noitneverP esubA ecnatsbuS )dednuf toN( .esuba evitaitinI tnemtaerT ))d(9 enimatehpmahtem fo ecnelaverp hgih htiw saera ni secivres tnemtaert enimatehpmahtem dnapxe oT enimatehpmA dna enimatehpmahteM -bb092( )d(415 .ceS )dednuf stnecselodA )8-bb092( A415 .ceS toN( .stnecseloda dna nerdlihc rof secivres esuba ecnatsbus noitnevretni ylrae edivorp ot stnarG dna nerdlihC roF secivreS noitnevretnI ylraE .ecnabrutsid lanoitome suoires a evah dna metsys ecitsuj elinevuj eht htiw devlovni era ohw stnecseloda stnecselodA dna nerdlihC rof erac etairporppa gnidivorp ni snoitcidsiruj lacol dna setatS tsissa ot ecnellecxe fo sretnec rof secivreS tnemtaerT esubA ecnatsbuS )7-bb092( 415 .ceS gnitaerc rof dna ,stnalahni dna enimatehpmahtem fo esu eht tneverp ot smargorp ,noitnevretni ylrae ,secivres tnemtaert esuba ecnatsbus gnidivorp rof tnemeerga evitarepooc ro stcartnoc ,stnarG .esuba dna esu ecnatsbus lanretam fo stceffe latnemnorivne dna latanirep yb detcapmi nerdlihc ronim ne m t pts dna rieht rof dna ,smelborp esu gurd rehto dna lohocla morf reffus ohw nemow mutraptsop dna tnangerp tnangerP rof smargorP moWtaeuTraaitnoP iseR tnem r l ed )1-bb092( 805 .ceS rof secivres tnemtaert laitnediser ytilauq hgih ,evisneherpmoc fo ytilibaliava eht dnapxe ot stnarG .secivres tnemtaert esuba ecnatsbus yrassecen rof edivorp ecnacifingiS lanoitaN dna lanoigeR fo ot seititne lacol dna setats fo yticapac esaercni dna ,ecnatsissa lacinhcet dna gniniart edivorp ,secitcarp )2-bb092( 905 .ceS tseb no egdelwonk esaercni ot dednetni seitivitca dnuf dna stnarg edivorp ot ytirohtua lareneG sdeeN tnemtaerT esubA ecnatsbuS ytiroirP )TASC( tnemtaerT esubA ecnatsbuS rof retneC )noitatiC .C.S.U 24( noitpircseD margorP eltiT tcA SHP noitceS £ ¡ )dednuf toN( .redrosid esuba ecnatsbus gnirucco gnirucco-oC dna ssenllI latneM suoireS -oc dna ssenlli latnem suoires a htiw slaudividni rof secivres tnemtaert detargetni edivorp ot stnarG fo tnemtaerT detargetnI eht rof stnarG )04-bb092( I025 .ceS .secivres desab-ytinummoc ot metsys ecitsuj lanimirc eht morf ssenlli latnem a htiw slaudividni trevid ot smargorp tnemelpmi dna poleved ot seititne smargorP noisreviD liaJ rof stnarG )83-bb092( G025 .ceS tiforpnon dna cilbup rehto htiw stnemeerga hguorht tca ot detcepxe era seetnarG .ssenlli latnem htiw stluda devlovni-ecitsuj rof secivres evorpmi ot smetsys fo noitamrofsnart eht etomorp oT )dednuf toN( htlaeH latneM ycnegremE rof sretneC )73-bb092( F025 .ceS .sretneC htlaeH latneM ycnegremE sa sretnec htlaeh dna slatipsoh fo noitangised troppus ot stnarG .eruliaf loohcs ot dael nac hcihw ,stpmetta edicius supmaC )b63 dna ,esuba ecnatsbus ,noisserped sa hcus ,smelborp htlaeh laroivaheb dna latnem htiw stneduts no secivreS htlaeH laroivaheB dna latneM -bb092( 2E-025 .ceS rof secivres ecnahne ot noitacude rehgih fo snoitutitsni ot stnarg troppus ot gnidnuf edivorp oT )dednuf toN( stnecselodA )a63-bb092( 1E-025.ceS .E 025 .ceS ni depoleved seigetarts noitnevretni ylrae dna noitneverp edicius tnemelpmoc ot stnarG dna nerdlihC roF noitneverP ediciuS .snoitazinagro gnitroppus htuoy dna dlihc rehto dna ,smargorp htlaeh latnem dna esuba ecnatsbus ,smetsys erac retsof ,smetsys ecitsuj elinevuj ,snoitutitsni lanoitacude ,sloohcs edulcni dluohs dna seicnega dna snoitutitsni gnivres-htuoy gnoma noitaroballoc )stnarG etatS( seigetartS noitneverP )63-bb092( E025.ceS etavirp/cilbup evlovni tsum stroffe hcuS .noitaroballoc etavirp/cilbup ni dednuorg ,seigetarts dna noitnevretnI ylraE ediciuS htuoY noitnevretni ylrae dna noitneverp edicius htuoy labirt ro ediwetats gnitnemelpmi dna gnipoleved ni sebirT dna setatS troppus ot redro ni stroffe noitneverp edicius roirp fo noitadnuof eht no dliub oT )dednuf toN( .secnabrutsid lanoitome suoires evah dna metsys sredneffO htuoY rof secivreS )53-bb092( D025 .ceS ecitsuj eht morf degrahcsid neeb evah ohw sredneffo htuoy ot secivres eracretfa edivorp ot stnarG .stroffe noitneverp esuba ecnatsbus yrassecen rof edivorp ecnacifingiS lanoitaN dna ot seititne lacol dna setats fo yticapac esaercni dna ,ecnatsissa lacinhcet dna gniniart edivorp ,secitcarp lanoigeR fo sdeeN htlaeH latneM fo ytiroirP )23-bb092( A025 .ceS tseb no egdelwonk esaercni ot dednetni seitivitca dnuf dna stnarg edivorp ot ytirohtua lareneG )SHMC( secivreS htlaeH latneM rof retneC .esuba enimatehpmahtem fo daerps ro/dna esu eht yaled ro ecuder ,tneverp ot ylevitceffe enevretni ot si laog ehT .tnempoleved erutcurtsarfni hguorht yticapac esaercni ot ro/dna desab-ecnedive noitciddA )e52-bb092( E915 .ceS dna evitceffe era taht snoitnevretni noitneverp dnapxe ot seitilacol stsissa margorp sihT .tnempoleved dna esubA enimatehpmahteM fo noitneverP erutcurtsarfni ro/dna snoitnevretni noitneverp enimatehpmahtem fo noisnapxe troppus ot stnarG seilimaf rieht .stcefed htrib detaler-lohocla dna emordnys dna snoitidnoC hcuS htiw slaudividnI rof )d52-bb092( D915 .ceS lohocla latef rof seigetarts tnemtaert dna noitneverp yduts ot ecnellecxe fo sretnec hsilbatse oT tnemtaerT dna stcefeD htriB detaleR-lohoclA dna emordnyS lohoclA lateF htiw slaudividnI rof secivreS no ecnellecxE fo retneC )noitatiC .C.S.U 24( noitpircseD margorP eltiT tcA SHP noitceS .stnedicni deifirev tcerroc ot seidemer rehto dna lagel tcA ssenllI latneM 72801CSU24 esu dna etagitsevni hcihw seicnega ycacovda dna noitcetorp tnednepedni ot stnarg sedivorp margorp htiw slaudividnI rof ycacovdA dna noitcetorP )711 .ceS( ,913-99 .L.P ehT .sthgir livic rieht fo snoitaloiv dna ,tcelgen ,esuba morf ssenlli latnem htiw slaudividni stcetorP .stneve citamuart fo yarra ediw a ot desopxe stnecseloda dna nerdlihc )evitaitinI ssertS citamuarT dlihC( .ssertS rof secitcarp ytinummoc evitceffe etomorp dna poleved ot ylevitaroballoc krow taht seetnarg detaleR dna ecneloiV ecneirepxE ohW )1-hh092( 285 .ceS fo krowten lanoitan a gnitaerc yb seussi amuart dlihc sesserddA .stneve citamuart decneirepxe snosreP fo smelborP eht sserddA ot stnarG evah ohw setatS detinU eht ni stnecseloda dna nerdlihc lla rof secivres dna tnemtaert evorpmI )margorp stnedutS yhtlaeH sloohcS efaS s'noitacudE fo tnemtrapeD ecneloiV dna nerdlihC )hh092( 185 .ceS eht rednu dedrawa sdnuF( .ecneloiv htiw gnilaed ni nerdlihc tsissa ot seitinummoc lacol dnuf oT )dednuf toN( .htuoy noitneverP esubA )b5-aa092( B605 .CES yb "sgurd bulc" fo esuba tneverp ot smargorp desab-ytinummoc rehto dna noitacude tuo yrrac oT sgurD bulC rehtO dna ysatscE rof stnarG )dednuf snaksalA evitaN dna snaidnI rof secivreS )a5-aa092( A605 ceS toN( .snaksalA evitaN dna snaidnI rof secivres tnemtaert ro noitneverp gard dna lohocla gnidivorP tnemtaerT ro noitneverP gurD dna lohoclA sselemoh slaudividnI )5-aa092( 605 .ceS eht rof smetsys tnemtaert htlaeh latnem dna lohocla/gurd evisneherpmoc fo tnempoleved eht sdnuF sselemoH fo tifeneB eht rof stnarG seitirohtuA rehtO .ecnabrutsid lanoitome suoires htiw nerdlihc dna ssenlli stnarG kcolB pihsrentraP ecnamrofreP )53-x003( )a( 0291.ceS latnem suoires htiw stluda rof secivres htlaeh latnem ytinummoc troppus ot setatS ot stnarg alumroF secivreS htlaeH latneM ytinummoC .noitaroballoc ycnega-itlum dna ,ecitcarp dediug htuoy dna nevird ylimaf ,erac tnetepmoc secnabrutsiD )4-ff092( )f(565 .ceS yllarutluc sezisahpme hcaorppa sihT .seilimaf rieht dna secnabrutsid lanoitome suoires htiw lanoitomE suoireS htiw nerdlihC rof secivreS & )ff092(165 .ceS nerdlihc fo sdeen eht teem ot erac fo smetsys dnapxe dna evorpmi ,tnemelpmi ot stnarg raey-xiS htlaeH latneM ytinummoC evisneherpmoC .nwo rieht no tnemtaert htlaeh latnem dedeen setatS ot stnarG HTAP ;ssensselemoH )53-cc092( )a(535 .ceS gniusrup ton era ohw slaudividni sselemoh no desucof si hcaertuO .ssenlli latnem suoires htiw morf noitisnarT ni ecnatsissA rof stcejorP & )12-cc092( 125 .ceS elpoep sselemoh ot secivres troppus rehto dna htlaeh latnem ,hcaertuo edivorp ot setatS ot stnarG )dednuf stnarG gniniarT htlaeH latneM )04-bb092( J025 .ceS toN( .lennosrep secivres ycnegreme rof gniniart dna ,ssenerawa ssenlli latnem no gniniart rof stnarG esubA ecnatsbuS )noitatiC .C.S.U 24( noitpircseD margorP eltiT tcA SHP noitceS NSS 3002YF-2002YF )a52-bb092( oN FN FN FN FN ;000,000,3 -1002YF 0002 seilimaF gninehtgnertS rof stnarG A915 .ceS NSS 3002YF-2002YF ;000,000,05$ sresubA ecnatsbuS )52bb-092( oN FN FN FN FN - 1002YF 2991 fo nerdlihC rof secivreS 915 .ceS NSS 3002YF-2002YF ecnacifingiS lanoitaN dna ;000,000,003$ lanoigeR fo sdeeN dna noitneverP )22-bb092( 2002 - seY 000,829,571$ 000,195,871$ 000,061,971$ 000,312,971$ -1002YF 6891 esubA ecnatsbuS fo ytiroirP 615 .ceS )PASC( noitneverP esubA ecnatsbuS rof retneC NSS 3002YF-2002YF stnarG kcolB pihsrentraP ;000,000,000,2$ ecnamrofreP tnemtaerT )53-x002 )a(( 0002 - seY 000,825,976,1$ 000,193,976,1$ 000,195,857,1$ 000,555,577,1$ - 1002YF 2991 dna noitneverP esubA ecnatsbuS 5391 .ceS evitaitinI NSS 2002YF-1002YF tnemtaerT enimatehpmA ))d(9-bb092( oN FN FN FN FN ;000,000,01$ -0002YF 0002 dna enimatehpmahteM )d(415 .ceS NSS 3002YF-2002YF stnecselodA dna nerdlihC )8-bb092( oN FN FN FN FN ;000,000,02$ -1002YF 0002 roF secivreS noitnevretnI ylraE A415 .ceS stnecselodA NSS 3002YF-2002YF dna nerdlihC rof secivreS )7-bb092( 2002 - seY 000,872,42$ 000,572,92$ 000,795,92$ 000,759,33$ ;000,000,04$-1002YF 0002 tnemtaerT esubA ecnatsbuS 415 .ceS nemoW mutraptsoP dna tnangerP rof )1-bb092( 4002 - seY 000,097,11$ 000,093,01$ 000,098,01$ 000,258,9$ NSS 3002YF-1002YF 2991 smargorP tnemtaerT laitnediseR 805 .ceS ecnacifingiS lanoitaN 000,312,843$ NSS 3002YF - 2002YF dna lanoigeR fo sdeeN tnemtaerT )2-bb092( 2002 - seY 000,679,613$ 000,949,893$ 000,701,423$ - 50 YF ;000,000,003$-1002YF 2991 esubA ecnatsbuS ytiroirP 905 .ceS )TASC( tnemtaerT esubA ecnatsbuS rof retneC )edoC )0002 ecnis( noitairporppA noitairporppA noitairporppA noitairporppA noitazirohtuA detaerC margorP fo emaN CSU24( dednuF revE 8002YF 7002YF 6002YF 5002YF raeY tcA SHP noitceS £ ¡ 2002 - seY 000,486,6$ 000,368,6$ 000,578,6$ 000,449,6$ NSS 3002YF-2002YF 0002 smargorP )83-bb092( 000,000,01$ -1002YF noisreviD liaJ rof stnarG G025 .ceS oN FN FN FN FN NSS 3002YF-2002YF 0002 htlaeH )73-bb092( ;000,000,52$ -1002YF latneM ycnegremE rof sretneC F025 .ceS 000,000,5$ -7002YF supmaC no secivreS )b63-bb092( 5002 - seY 000,319,4$ 000,059,4$ 000,059,4$ 000,005,1$ ;000,000,5 -6002YF 4002 htlaeH laroivaheB dna latneM 2E-025.ceS ;000,000,5$ -5002YF oN FN FN FN FN NSS 3002-2002 0002 stnecselodA dna )a63-bb092( 000,00,57$ -1002 nerdlihC roF noitneverP ediciuS 1E-025.ceS 000,000,03$ - 7002YF )stnarG )63-bb092( 5002 - seY 000,674,92$ 000,028,71$ 000,028,71$ 000,429,6$ 000,000,81$ - 6002YF 4002 etatS( seigetartS noitneverP dna E025 .ceS 000,000,7$ - 5002YF noitnevretnI ylraE ediciuS htuoY oN FN FN FN FN NSS 3002YF-2002YF 0002 sredneffO htuoY rof secivreS )53-bb092( ;000,000,04$ -1002YF D025 .ceS NSS 3002YF-2002YF ecnacifingiS )23-bb092( 2002 - seY 000,001,611$ 000,362,362$ 000,434,801$ 000,206,131$ ;000,000,003$ 8891 lanoitaN dna lanoigeR fo A025 .ceS -1002YF sdeeN htlaeH latneM fo ytiroirP )SHMC( secivreS htlaeH latneM rof retneC NSS 3002YF-2002YF noitciddA dna esubA )e52-bb092( 2002 - seY 000,769,2$ 000,069,3$ 000,069,3$ 000,721,5$ ;000,000,01$ -1002YF 0002 enimatehpmahteM fo noitneverP E915 .ceS seilimaf riehT dna snoitidnoC hcus htiw slaudividnI rof tnemtaerT dna stcefeD htriB detaleR-lohoclA dna emordnyS NSS 3002YF-2002YF lohoclA lateF htiw slaudividnI rof )d52-bb092( 2002 - seY 000,128,9$ 000,128,9$ 000,128,9$ 000,000,01$ ;000,000,5$ -1002YF 0002 secivreS no ecnellecxE fo retneC D915 .ceS NSS 3002YF-2002YF ;000,000,52$ emordnyS lohoclA )c52-bb092( 2002 - seY FN FN FN FN - 1002YF 0002 lateF htiw slaudividnI rof secivreS C915 .ceS NSS 3002YF-2002YF gniknirD )b52-bb092( 8002 - seY 000,404,5$ FN FN FN ;000,000,52$ -1002YF 0002 egarednU ecudeR ot smargorP B915 .ceS )edoC )0002 ecnis( noitairporppA noitairporppA noitairporppA noitairporppA noitazirohtuA detaerC margorP fo emaN CSU24( dednuF revE 8002YF 7002YF 6002YF 5002YF raeY tcA SHP noitceS )evitaitinI ssertS citamuarT dlihC( 2002 - seY 000,290,33$ 000,860,82$ 000,264,92$ 00.000,067,92$ NSS 6002YF-2002YF 0002 .ssertS detaleR dna ecneloiV )1-hh092( ;000,000,05$-1002YF ecneirepxE ohW snosreP fo 285 .ceS smelborP eht sserddA ot stnarG 2002 - seY 000,200,39$ 000,651,39$ 000,202,28$ 000,837,87$ NSS 3002YF-2002YF 0002 ecneloiV dna nerdlihC )hh092( ;000,000,001$-1002YF 185 .ceS NSS- tneuqesbuS noitneverP esubA sgurD bulC )b5-aa092( oN FN FN FN 000,583,4$ ;000,000,01$ 0002 rehtO dna ysatscE rof stnarG B605 .CES - 1002YF NSS 3002YF snaksalA evitaN dna )a5-aa092( oN FN FN FN FN -2002YF ;000,000,51$ 0002 snaidnI rof secivreS tnemtaerT A605 ceS - 1002YF ro noitneverP gurD dna lohoclA NSS 3002YF-2002YF slaudividnI sselemoH )5-aa092( 2002 - seY 000,006,23$ 000,715,43$ 000,519,34$ 000,379,53$ ;000,000,05$ 4891 fo tifeneB eht rof stnarG 605 .ceS - 1002YF seitirohtuA rehtO NSS 3002YF-2002YF stnarG kcolB 53-x003 0002 - seY 000,537,993$ 000,652,824$ 000,646,824$ 000,657,234$ ;000,000,054$ 2991 pihsrentraP ecnamrofreP secivreS )a( 0291.ceS - 1002YF htlaeH latneM ytinummoC NSS 3002YF-2002YF secnabrutsiD )4-ff092( 0002 - seY 000,062,201$ 000,870,401$ 000,870,401$ 000,211,501$ ;000,000,001$ 2991 lanoitomE suoireS htiw nerdlihC )f(565 .ceS -1002YF rof secivreS htlaeH latneM & )ff092( ytinummoC evisneherpmoC 165 .ceS raey hcae 000,000,57$ setatS ot stnarG HTAP )53-cc092( 2002 - seY 000,313,35$ 000,162,45$ 000,162,45$ 000,908,45$ - 3002YF-1002YF 0991 ;ssensselemoH morf noitisnarT )a(535 .ceS ;alumroF ni ecnatsissA rof stcejorP & )12-cc092( 125 .ceS oN FN FN FN FN NSS 3002YF-2002YF 0002 stnarG gniniarT htlaeH latneM )04-bb092( ;000,000,52 - 1002YF J025 .ceS esubA NSS 3002YF-2002YF ecnatsbuS gnirucco-oC dna ssenllI )04-bb092( oN FN FN FN FN 000,000,04$ -1002YF 0002 latneM suoireS fo tnemtaerT I025 .ceS detargetnI eht rof stnarG )edoC )0002 ecnis( noitairporppA noitairporppA noitairporppA noitairporppA noitazirohtuA detaerC margorP fo emaN CSU24( dednuF revE 8002YF 7002YF 6002YF 5002YF raeY tcA SHP noitceS ".yrasseceN eb yam sa smuS hcuS" snaem NSS ;"gnidnuF oN" snaem FN :setoN .9002YF - 4002YF snoitacifitsuJ tegduB ASHMAS :ecruoS )126 142CSU24 0002 - seY 000,890,47$ 000,240,67$ 000,940,67$ 000,608,57$ elbacilppa toN -89 .L.P( tnemeganaM margorP 126-89 4891 .L.P;103 .ceS NSS 3002YF-3991YF tcA ssenllI latneM htiw slaudividnI 72801CSU24 0002 - seY 000,088,43$ 000,000,43$ 000,000,43$ 000,343,43$ ;000,005,91$ 6891 711 .ceS - 2991YF rof ycacovdA dna noitcetorP ,913-99 .L.P )edoC )0002 ecnis( noitairporppA noitairporppA noitairporppA noitairporppA noitazirohtuA detaerC margorP fo emaN CSU24( dednuF revE 8002YF 7002YF 6002YF 5002YF raeY tcA SHP noitceS .ASHMAS :ecruoS ¡ ¡ .weiveR looT gnitaR tnemssessA margorP s'tegduB dna tnemeganaM fo eciffO 3002 yb deriuqeR .2 .yrevocer fo evitroppus sdneirf ro/dna ylimaf htiw noitcaretni sa llew sa ,spuorg pleh-fles ro yrevocer yratnulov ni noitapicitrap tneilc yb derusaem si "yrevoceR fo troppuS laicoS" ,RTA roF .1 :setoN .ASHMAS :ecruoS ¡ ¡ SAMHSA Website: http://www.samhsa.gov. SAMHSA grant awards by state: http://www.samhsa.gov/statesummaries/index.aspx. FY2008 Budget justification: http://www.samhsa.gov/Budget/FY2008/ SAMHSA08CongrJust.pdf. National Outcome Measures: http://www.nationaloutcomemeasures.samhsa.gov/. FY2000 Reauthorization Language: http://www.samhsa.gov/legislate/Sept01/ childhealth_toc.htm. Center for Mental Health Services: http://mentalhealth.samhsa.gov/cmhs/. Center for Substance Abuse Prevention: http://prevention.samhsa.gov/. Center for Substance Abuse Treatment: http://csat.samhsa.gov/. Office on Applied Statistics: http://oas.samhsa.gov/. SAMHSA Report on Co-occuring Disorders: http://www.oas.samhsa.gov/CoD/CoD.pdf. SAMHSA report on Performance Partnerships: http://www.nationaloutcomemeasures.samhsa.gov/./PDF/performance_partnership.pdf. National Outcome Measures: http://nationaloutcomemeasures.samhsa.gov/./outcome/ index_2007.asp. SAMHSA grant awards to states: http://www.samhsa.gov/grants/. Garrett Lee Smith grantee activities: http://www.sprc.org/grantees/show AllStateTribe.asp (state grantees) and http://www.sprc.org/grantees/C_Udescriptions.asp (campus grantees). Ramya Sundararaman Analyst in Public Health rsundararaman@crs.loc.gov, 7-7285 ------------------------------------------------------------------------------ For other versions of this document, see http://wikileaks.org/wiki/CRS-RL33997