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Integrating Mental Health & Substance Abuse Strategies

Improving the Outcomes of State Health & Human Service Initiatives

A Workshop for Senior State Officials

This seminar offered State executive and legislative officials and senior-level State policymakers information to develop a better understanding of the individual insurance market and the impact that reforms implemented have had to date. It was held in Albuquerque, New Mexico, July 19-21, 1999.

About the Workshop Sponsor.


All across the country, States are actively involved in a wide variety of innovative health and human service program activities, including such things as welfare reform, managed care contracting, health care coverage expansions, and child welfare initiatives. The desired outcomes of these activities vary according to the nature of the initiative and may include:

  • Moving people from welfare to work.
  • Ensuring comprehensive employee health benefits.
  • Focusing on behavioral health issues in the juvenile justice system.
  • Extending health care coverage to previously uninsured individuals through programs such as State Children's Health Insurance Programs (SCHIPs).
  • Providing safe and supportive child welfare programs.

One thing these initiatives often have in common, however, is that in many cases a significant number of individuals within their target populations may suffer from mental health or substance abuse (MH/SA) problems. For example, the U.S. General Accounting Office (GAO) estimates that 78 percent of young children in foster care come from families in which substance abuse is a significant factor in placing the child out of home care. Additionally, two of the major health problems facing adolescents—an age group that contains many potential SCHIP enrollees—are depression and substance abuse problems.

MH/SA problems can create significant barriers to the achievement of the goals and objectives of broader health and human service program and policy initiatives. Health care initiatives that do not adequately address the MH/SA problems of target populations they serve may result in fragmented care, significant unmet need, and ultimately, higher health care spending. All the training in the world may not be enough to help a former welfare recipient with a serious substance abuse problem hold a job. Unaddressed mental health or substance abuse problems may doom any efforts to reunite and strengthen families.

Although a compelling argument may be made for addressing these MH/SA problems as part of these broader initiatives, doing so is not necessarily a simple task. The challenges that often exist across States include:

  • Lack of a clear understanding of the nature and prevalence of MH/SA problems within the target populations for specific programs.
  • Dynamic changes in the financing and delivery of MH/SA services and the need for a better understanding of the outcomes associated with different treatment options.
  • Challenges in designing and implementing effective approaches to addressing MH/SA problems in the context of these broader health and social policy initiatives.
  • Bureaucratic obstacles to collaboration across State agencies possessing the combined expertise needed to design effective strategies.


The AHCPR User Liaison Program designed this workshop to help State officials address these challenges. The workshop objectives were developed to provide participants with:

  • Important research about the nature of the MH/SA problems that exist within program populations.
  • Information on key trends and developments in the finance and delivery of MH/SA services.
  • The opportunity to examine the cutting-edge efforts of States that are promoting better outcomes from program initiatives by incorporating MH/SA strategies within them.
  • An examination of issues and opportunities regarding evaluation and impact of MH/SA related strategies and interventions.
  • A forum for discussing challenging issues within their own States and for sharing insights and lessons learned among participants.

It should be emphasized that the goal of the workshop was not designed to tell State officials what they should do, but rather to provide them with useful information that can help them make more informed decisions.


This workshop was not designed exclusively for officials from State mental health and substance abuse agencies. It was, however, designed to address the needs of a broad range of State officials responsible for the design, implementation, and evaluation of new health and human service programs.

The 60 workshop participants were health officials from a broad range of organizations, including: State legislatures, State Medicaid agencies, and State health departments as well as State MH/SA agencies, human and social service agencies, State youth and families departments, and governors' offices.

Workshop Sessions


The User Liaison Program (ULP) disseminates health services research findings in easily understandable and usable formats through interactive workshops. Workshops and other support are planned to meet the needs of Federal, State, and local policymakers, and other health services research users, such as purchasers, administrators, and health plans.

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