United States General Accounting Office GAO Testimony Before the Subcommittee on Oversight and Investigations, Committee on Education and the Workforce House of Representatives For Release on Delivery Expected at 11:00 a.m. Tuesday, June 24, 1997 SUBSTANCE ABUSE AND VIOLENCE PREVENTION Multiple Youth Programs Raise Questions of Efficiency and Effectiveness Statement of Carlotta C. Joyner, Director Education and Employment Issues Health, Education, and Human Services Division GAO/T-HEHS-97-166 Substance Abuse and Violence Prevention: Multiple Youth Programs Raise Questions of Efficiency and Effectiveness Mr. Chairman and Members of the Committee: I am pleased to be here today to discuss our work on federal substance-abuse and violence-prevention programs for youths. Drug and alcohol abuse (substance abuse) and violence by youths are serious problems confronting our nation. After declining in the eighties, drug use rates among school-age youths increased between 1992 and 1995 for more than 10 different types of drugs. For example, one study reported that the rate of marijuana use by eighth grade students more than doubled—from about 7 to about 16 percent—and the rate for twelfth graders rose from about 22 to about 35 percent. During this period, the rate of alcohol use remained above 70 percent for twelfth graders.1 The Congress found in 1994 that about 3 million thefts and violent crimes took place on or near school campuses each year—more than 16,000 incidents per school day.2 About one in five high school students regularly carried a firearm, knife, razor, club, or other weapon. The federal government, state and local governments, and private organizations have all responded to these problems by establishing and funding a wide range of programs and activities intended to reduce or prevent youth substance abuse and violence. My testimony today, based on a number of studies we have issued, will focus on (1) the information available about substance-abuse and violence-prevention programs and the federal investment in them, (2) what is known about the effectiveness of federally funded programs in reducing youth substance abuse and violence, and (3) improving the federal effort by focusing more on accountability and results. (A list of related GAO products appears at the end of this testimony.) Although some of the data we present—for example, on programs and their funding—are from 1994 and 1995, the issues we are addressing have changed little since our work was done. In summary, our reviews have raised questions about the efficiency and effectiveness of the federal effort in this area. The system that has developed—of multiple federal programs dispursed among several agencies—has created the potential for inefficient service as well as difficulty for those trying to access the most appropriate services and funding sources. For example, we identified 70 federal programs that 1 Monitoring the Future, National Institutes of Health, National Institute on Drug Abuse (Rockville, Md.: 1996). 2 20 U.S.C. 7102 (3). Page 1 GAO/T-HEHS-97-166 Substance Abuse and Violence Prevention: Multiple Youth Programs Raise Questions of Efficiency and Effectiveness could have been used in fiscal year 1995 to provide substance-abuse and/or violence-prevention services for youths. These programs were located in 13 federal departments or other federal entities and had appropriations of about $2.4 billion. In addition, state, county, and local governments, as well as private sources provided billions of dollars for substance-abuse prevention and treatment efforts for adults and youths. Often, insufficient information exists on these programs’ performance. Although we identified some promising approaches for preventing substance abuse and violence, our work suggests that additional research is needed to further test these approaches’ effectiveness and their applicability to different populations in varied settings. In addition, a major information gap exists for federal decisionmakers who need to know the accomplishments of these individual federal programs and the combination of those programs. The Government Performance and Results Act of 1993 (GPRA) can move agencies toward a more integrated approach to meeting common goals and a greater emphasis on accountability and assessment of program results. This emphasis will require agencies not only to better document federal programs’ progress toward achieving their goals of preventing substance abuse and violence, but also to identify which service delivery approaches have been effective and encourage greater use of more effective models. Stemming the tide of youth drug use and violence is a high priority on the Background national policy agenda. For example, one of the five goals of the Office of National Drug Control Policy (ONDCP), created by the Congress in 1988 to lead the nation’s war on drugs, is to “educate and enable America’s youth to reject illegal drugs as well as alcohol and tobacco.”3 In addition, one of the National Education Goals, adopted by the Congress in 1994, is that “by the year 2000, all schools in America will be free of drugs, violence, and the unauthorized presence of firearms and alcohol, and will offer a disciplined environment that is conducive to learning.”4 In fiscal year 1994, $1.8 billion, 40 percent of the $4.4 billion federal budget authority for 3 National Drug Control Strategy, 1997, ONDCP (Washington, D.C.). 4 20 U.S.C. 5812 (7). Page 2 GAO/T-HEHS-97-166 Substance Abuse and Violence Prevention: Multiple Youth Programs Raise Questions of Efficiency and Effectiveness substance-abuse prevention and treatment, was targeted to prevention activities for adults and youths.5 Preventing Substance The major goals of substance-abuse prevention programs are preventing Abuse or eliminating drug and alcohol abuse and averting substance abuse- related problems. Prevention activities vary and are directed at different groups and delivered in multiple settings. For example, activities may include • providing information and education to increase knowledge of substance abuse and alternative drug-free lifestyles; • teaching skills to resist drug and alcohol influences, solve problems, and make decisions; • developing interventions to control the sale and distribution of illegal drugs; and • encouraging communities to implement responses to drug and alcohol use. Activities may be directed toward • the general population to alter social, psychological, and environmental factors that may inflence the prevalence and outcomes at the community level; • individuals or subgroups at risk of developing substance abuse behaviors to reduce risk factors6 and enhance protective factors7 related to the onset of use and the progression to abuse and dependence; or 5 In our report, Drug and Alcohol Abuse: Billions Spent Annually for Treatment and Prevention Activities (GAO/HEHS-97-12, Oct. 8, 1996), we noted that ONDCP estimated total budget authority of $4.7 billion for fiscal year 1996, but we did not analyze the percentage that was authorized for treatment compared with prevention. 6 Reducing risk factors focuses on trying to lessen the negative effect of factors that impinge on one’s life that have been shown or theorized to relate to drug and alcohol use. These factors include availability of drugs and alcohol, community norms favorable to drug and alcohol use, extreme economic deprivation, family history of problems with use, favorable parental attitudes and involvement in problem use, early and persistent antisocial behavior, academic failure, alienation and rebellion, and friends who engage in problem behavior. 7 Enhancement of protective factors focuses on increasing an individual’s resilience in dealing with potentially high-risk situations (such as dysfunctional families, schools, and communities). Researchers in substance abuse prevention have hypothesized that more resilient individuals are less likely to engage in drug use. Optimism, empathy, insight, intellectual competence, self-esteem, direction or mission, and determination and perseverance are seven major factors affecting youths’ resilience. The coping or life skills associated with these seven factors are emotional management skills, interpersonal social skills, intrapersonal reflective skills, academic and job skills, ability to restore self-esteem, planning and life skills, and problem-solving ability. Page 3 GAO/T-HEHS-97-166 Substance Abuse and Violence Prevention: Multiple Youth Programs Raise Questions of Efficiency and Effectiveness • individuals who use one or more drugs but who do not yet meet diagnostic criteria for a substance abuse disorder to interrupt the progression from use to abuse, addiction, and social dysfunction. Service delivery settings may include the classroom, peer support groups, the home, and the community, or a combination of these. Preventing Violence Schools use a wide variety of educational and noneducational approaches and programs to address violence. Many school-based violence-prevention programs operate under the premise that violence is a learned behavior. In general, these programs focus on primary prevention; that is, they seek to prevent violence before it occurs. Although school-based violence- prevention programs and strategies vary, most fall within three broad categories: • Educational and curricula-based programs: These programs seek to teach students the skills to manage their behavior and resolve conflict nonviolently. Examples are programs that focus on conflict resolution or gang aversion. • Environmental modification: These programs focus on either the social or physical environment. Examples include after-school recreational and academic activities and metal detectors and gates limiting access to building entrances and exits. • School organization and management: These programs focus on establishing school discipline policies and procedures governing student behavior, creating alternative schools, and developing cooperative relationships with police and other government agencies. Multiple sources currently fund a wide variety of substance-abuse Prevention Efforts prevention and violence-prevention programs. The federal government, Span Many Agencies while a major investor in prevention programs, is just one of several and Programs contributors. State and local governments, as well as the private sector, also contribute to the billions spent annually on prevention efforts. The current array of prevention services, however, does not constitute an integrated approach to substance abuse and violence problems, raising questions about overlapping services and duplication created by these many programs. Multiple Federal Programs The federal government funds a wide array of programs to prevent With Many Similar Services substance abuse and violence. For youths, many of these services are Page 4 GAO/T-HEHS-97-166 Substance Abuse and Violence Prevention: Multiple Youth Programs Raise Questions of Efficiency and Effectiveness provided through programs targeted to delinquent youths or youths considered at risk for delinquency or drug use.8 In our 1996 report on delinquent and at-risk youths, we identified more than 131 programs administered by 16 federal departments and other agencies.9 At that time, we estimated that the amount of the federal appropriations for these programs dedicated to at-risk and delinquent youths exceeded more than $4 billion in fiscal year 1995. Further analysis showed that 70 of the 131 programs were authorized to provide either substance-abuse prevention or violence-prevention services or both to the youths they served (see app. I).10 For example, 34 of these programs may provide both types of prevention services. The 70 prevention programs we identified are administered by 10 federal agencies, one presidential council, and a federal foundation. The Departments of Health and Human Services (HHS), Justice, and Education administer 48 of these programs—nearly 70 percent of all the programs. The fiscal year 1995 appropriations for the prevention programs for youths in these three departments totaled about $1 billion, about 42 percent of the total federal appropriation of about $2.4 billion for all 70 programs.11 Although we have not fully examined these multiple programs, the implications of having multiple, unintegrated substance-abuse and violence-prevention programs might be similar to those for employment training programs—an area we have examined. In fiscal year 1995, we identified 163 federal employment training programs disbursed among 15 departments and agencies. We recently concluded that consolidating these programs could probably reduce the cost of providing job training services because of the efficiencies achieved by eliminating duplicative 8 The term “at risk” can have different meanings in different contexts. We are using the term in a broad sense to refer to youths who, due to certain characteristics or experiences, are statistically more likely than other youths to encounter certain problems—legal, social, financial, educational, emotional, and health—in the future. 9 At-Risk and Delinquent Youth: Multiple Federal Programs Raise Efficiency Questions (GAO/HEHS-96-34, Mar. 6, 1996). 10 Our original analysis focused on 17 types of services or activities that programs could provide to at-risk or delinquent youths. Of those, we identified five that focused on substance-abuse prevention or violence prevention: conflict resolution, crime/violence intervention, focused activities (activities for preventing juvenile delinquency by offering positive, alternative ways for youths to spend their time, such as recreation and sports), gang intervention, and substance-abuse intervention. For the analysis presented in this testimony, we did not update information about the appropriations. 11 This is a conservative estimate because it is based on information for only 61 of the 70 programs; for the remaining 9 programs, officials were unable to estimate the portion of total appropriations that was dedicated to youths (ages 5 through 24). Page 5 GAO/T-HEHS-97-166 Substance Abuse and Violence Prevention: Multiple Youth Programs Raise Questions of Efficiency and Effectiveness administrative activities. Furthermore, consolidating similar programs could improve opportunities to increase service delivery effectiveness.12 Contributions From State, county, and local governments also help fund substance-abuse and Nonfederal Sources violence-prevention programs. In fiscal year 1994, they reported spending $1.6 billion in addition to the $4.4 billion federal budget authority for substance-abuse prevention and treatment for adults and youths. Forty percent of the federal funds and 12 percent of the state, county, and local funds were targeted to prevention services. Total spending by state and local governments, however, probably does exceed these reported expenditures.13 Comprehensive data on private funding of substance-abuse prevention activities over time are sparse. For example, the National Drug and Alcoholism Treatment Unit Survey (NDATUS), which compiled private contributions from various sources, focused on treatment only.14 Data on private donations from foundations, however, show that the top 25 contributors awarded $39.4 million in grants for substance-abuse treatment and prevention programs for adults and youths during 1993 and 1994, the latest years for which grant data were available at the time of our report. The grants ranged from $306,342 to about $18.5 million. These grants were provided to nonprofit organizations in the United States and abroad for substance-abuse treatment and prevention programs, including counseling, education, residential care facilities, halfway houses, support groups, family services, community programs, and services for children of drug-dependent parents. Grants were also awarded for medical research on substance abuse and media projects on substance-abuse prevention. Population groups receiving the largest grant amounts were alcohol or drug abusers, children and youths, women and girls, economically disadvantaged individuals, offenders or ex-offenders, and minorities. Our previous work has identified promising approaches for both Effectiveness of substance-abuse prevention and violence prevention. Evaluation research Prevention Programs provides some information about effective program models and their 12 Department of Labor: Challenges in Ensuring Workforce Development and Worker Protection (GAO/T-HEHS-97-85, Mar. 6, 1997). 13 GAO/HEHS-97-12, Oct. 8, 1996. 14 Sponsored by the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Office of Applied Studies, NDATUS is a census of substance-abuse treatment units in the United States and the U.S. territories. Page 6 GAO/T-HEHS-97-166 Substance Abuse and Violence Prevention: Multiple Youth Programs Raise Questions of Efficiency and Effectiveness outcomes. But often less information is available on the effectiveness of individual programs funded at the national, state, and local levels by the federal government or by sets of such programs addressing similar goals. Promising Program Models Research on the effectiveness of substance-abuse and violence-prevention Identified programs has identified promising approaches in both areas. Our recent review of the literature on the effectiveness of substance-abuse prevention programs identified two promising approaches for school-age youths.15 The first approach—referred to as the psychosocial approach— emphasizes improving individuals’ drug-resistance skills and generic problem-solving/decision-making skills and modifying attitudes and norms that encourage drug use. The second approach—the comprehensive approach—involves the coordinated use of multiple societal institutions, such as family, community, and schools, for delivering prevention programs. Both approaches have reduced student drug use as well as strengthened individuals’ ability to resist drugs in both short- and longer term programs.16 Although other approaches, such as information dissemination, affective education, and alternatives to drug use, have been used in previous programs, they have not shown consistent effectiveness when used individually. They have been included, however, in promising comprehensive approaches to prevention. In our 1995 report on school safety, we described the characteristics of promising school-based violence-prevention programs.17 These characteristics are (1) a comprehensive approach, (2) an early start and long-term commitment, (3) strong leadership and disciplinary policies, (4) staff development, (5) parental involvement, (6) interagency partnerships and community linkages, and (7) a culturally sensitive and developmentally appropriate approach. For example, teaching students early about making positive choices and linking school-based programs to community groups, such as law enforcement or service agencies, are approaches used by promising programs. 15 Drug Control: Observations on Elements of the Federal Drug Control Strategy (GAO/GGD-97-42, Mar. 14, 1997). 16 Some of the most notable programs include (1) the Life Skills Training Prevention Program (using a psychosocial approach), which showed that 44 percent less intervention participants reported use of three drugs over a specified period of time, as compared with control group participants, and (2) the Midwestern Prevention Project (using a comprehensive approach), also known as Project Star or I-Star, which showed a 20- to 40-percent net reduction in the use of two drugs by school-age youths over a 3-year period. 17 School Safety: Promising Initiatives for Addressing School Violence (GAO/HEHS-95-106, Apr. 25, 1995). Page 7 GAO/T-HEHS-97-166 Substance Abuse and Violence Prevention: Multiple Youth Programs Raise Questions of Efficiency and Effectiveness We also identified four programs that have received national recognition for their innovative approach to addressing school violence: the Anaheim Union School District program in California, which stresses school management and order issues; the Paramount, California, program in which schools use an anti-gang curriculum to reduce gang membership among students who participated in the program; a Dayton, Ohio, program that provides students with social skills and anger-management training; and a New York City program that uses conflict-resolution and peer- mediation training to reduce student fighting. Preliminary evaluations of these programs concluded that they showed initial signs of success because student participants’ attitudes and behaviors had changed. Reported participant changes included (1) new attitudes toward violence and gang membership; (2) less disruptive behavior, including fewer fights; and (3) less contact with the criminal justice system. For example, public health officials have regarded New York City’s Resolving Conflict Creatively Program as one of the most promising violence-prevention programs. Early evaluation results of this program showed that teachers observed less student name calling and fewer verbal put-downs by students. Teachers also agreed that the mediation program has helped students take more responsibility for solving their own problems. Additional Research While our work has identified promising approaches, more and better Needed on Effectiveness of evaluation research is needed on program effectiveness. For example, Program Approaches regardless of the early positive results of certain substance-abuse prevention approaches, experts suggest that additional research is needed to better identify and understand the elements of effective prevention. They say substantiating early program results through further research and evaluation is important to advancing promising substance-abuse prevention approaches. Examples of useful initiatives for future research include determining the combination of approaches that yields the most significant outcome results and assessing the approaches that work best for different population groups. We reached similar conclusions about violence-prevention programs. While the early results of violence-prevention programs proved a useful starting point, a general consensus exists that the methodological rigor of these studies must be improved to determine program effectiveness. To improve the usefulness of future evaluations, designing stronger impact or effectiveness studies should be emphasized. Design issues requiring Page 8 GAO/T-HEHS-97-166 Substance Abuse and Violence Prevention: Multiple Youth Programs Raise Questions of Efficiency and Effectiveness particular attention include sampling techniques, longitudinal assessment, random assignment, and collection of data on impact and outcome measures. Conducting such evaluations, according to officials we interviewed, depends on obtaining grants or private funds specifically for that purpose. Fortunately, some agencies have now begun funding impact evaluations to study the effectiveness of specific school-based interventions. For example, the Centers for Disease Control and Prevention, the National Institute of Justice, and the National Institute of Mental Health awarded 26 grants totaling approximately $28 million for this purpose during fiscal years 1993 and 1994. Information Generally From a decision-making standpoint, what is needed—but often not Lacking About Overall available—is information about the overall effectiveness of a particular Results of Federal program. That is, to what extent are individual programs, such as the Safe and Drug-Free Schools and Communities Act of 1994 program, achieving Programs the expected results? Information is needed about such programs because decisions about appropriate funding levels and sources are made at the program level. In addition, with accurate information about the overall results of the federal programs addressing similar goals, such as preventing substance abuse and violence, more effective use could be made of those funds. First, inefficiencies in the use of funds, such as those resulting from overlapping and duplicative programs, could be reduced through retargeting or combining programs. Second, policymakers could better ensure that the activities funded—in this case, the individual program models used—are the ones most likely to achieve program goals. GPRA can be a useful mechanism for the Congress and federal agencies to Increasing Emphasis improve the combined federal effort against substance abuse and violence on Accountability and among youths. GPRA requires agencies to ask fundamental questions about Program Results their missions, their goals and objectives for achieving those missions, how they will measure their performance, and how they will use performance measurement information to improve their efforts. It forces federal agencies to shift the focus from such traditional concerns as staffing and activity levels to a single, overriding issue: results. Specifically, GPRA directs agencies to consult with the Congress, obtain the views of other stakeholders, and clearly define their missions. It also requires agencies to establish long-term strategic goals as well as annual Page 9 GAO/T-HEHS-97-166 Substance Abuse and Violence Prevention: Multiple Youth Programs Raise Questions of Efficiency and Effectiveness performance goals linked to the strategic goals. Agencies must then measure their performance according to their goals and report to the President and the Congress on their success. In addition to ongoing performance monitoring, agencies are expected to identify performance gaps in their programs and to use information from evaluation studies to improve programs. GPRA requires that federal agencies develop strategic plans covering at least 5 years and submit them to the Congress and the Office of Management and Budget no later than September 30, 1997. These plans must identify the agencies’ long-term strategic goals and describe how the agencies intend to meet these goals through their activities and resources. The plans are expected to reflect coordination with other federal agencies that are trying to achieve similar strategic goals or have activities or functions similar to theirs. Beginning with fiscal year 1999, federal agencies are to use their strategic plans to prepare annual performance plans. These performance plans are to include annual goals linked to the activities described in budget presentations as well as the indicators the agency will use to measure performance according to the results-oriented goals. Agencies are subsequently to report each year on the extent to which they meet their goals, provide an explanation regarding any goals they did not meet, and describe the actions needed to meet any unmet goals. For substance-abuse and violence-prevention programs, this shift to a focus on results can help bridge the gap between accurate data about effective program models and the performance of individual federal programs. For example, current research has identified aspects of effective substance-abuse prevention programs and characteristics of promising approaches for violence-prevention programs. This research, however, often consists of one-time efforts, and the extent to which these studies influence other programs’ design and service delivery is uncertain. GPRA, on the other hand, provides an incentive for agency and program personnel to systematically assess what is working in their programs and expand or replicate those practices. GPRA also provides an early warning system for identifying goals and objectives that are not being met so that agency and program staff can replace ineffective practices with effective ones. Measuring how well programs are working can present a major challenge, however, especially when funds are distributed through block grants—as is the case with many of the programs we identified. For example, most of Page 10 GAO/T-HEHS-97-166 Substance Abuse and Violence Prevention: Multiple Youth Programs Raise Questions of Efficiency and Effectiveness the dollars distributed by HHS’ SAMHSA in fiscal year 1996—including the $1.2 billion to states for substance-abuse prevention and treatment services—was distributed through block grants.18 The agency faces the challenge of balancing the flexibility it affords states to set priorities on the basis of local need with its own need to hold the states accountable for achieving SAMHSA’s goals. Recognizing this challenge, HHS is transforming its SAMHSA block grants into Performance Partnership Grants (PPG). Under PPGs, the states and federal governments will negotiate an arrangement that identifies specific objectives and performance measures regarding outcomes, processes, and these outcomes’ capacity to be reached in 3 to 5 years. This appears to be a promising strategy because it gives states more control over their funding decisions while encouraging them to accept greater accountability for results. The federal investment in youth substance-abuse and violence-prevention Conclusions programs is intended to help America’s youths avoid the harmful consequences, to themselves and society, of substance abuse and violent behavior. Although some of these individual federally funded efforts have shown value, concern still exists about the overall efficient use of federal funds and the effectiveness of the services they provide. An integrated, coordinated federal effort is lacking. Such an effort would consider the substantial investment by other levels of government and the private sector and have clear accountability for results. Better information is needed about which program approaches are most effective with which groups of youths in preventing substance abuse and violence. We also need such information to better link results to overall federal funding for programs. GPRA is an important tool for bridging this gap between knowledge about individual program approaches and federal funding for programs because it provides the needed accountability and an incentive for agencies to set measurable goals for their programs and to periodically assess progress toward those goals. Mr. Chairman, this concludes my prepared statement. I would be pleased to respond to any questions you or members of the Subcommittee may have. 18 Substance Abuse and Mental Health: Reauthorization Issues Facing the Substance Abuse and Mental Health Services Administration (GAO/T-HEHS-97-135, May 22, 1997). Page 11 GAO/T-HEHS-97-166 Appendix I Federal Substance-Abuse Prevention and Violence-Prevention Programs for Youths Dollars in millions Type of prevention assistance for which funds are available Estimate of federal Substance- funding for youths abuse Agency and program during FY 1995 prevention Violence prevention Both Corporation for National and Community Service (three programs) Foster Grandparent Program $67.8 X Retired and Senior Volunteer Program 35.7 X Volunteers in Service to America 13.7 X Subtotal $117.2 Department of Agriculture (four programs) 4-H Youth Development 63.0 X Education—Cooperative Extension System Children, Youth, and Families at Risk 10.0 X Initiative—Cooperative Extension System Partnerships Against Violence Network Not available X Youth Conservation Corps 3.0 X Subtotal $76.0 Department of Defense (two programs) Child Development and Youth 8.0 X Programs—“At-Risk” Youth Program Community Outreach Pilot Program 8.0 X Subtotal $16.0 Department of Education (five programs) Civic Education Program 4.5 X Drug-Free Schools and 25.0 X Communities—National Programs Family and Community Endeavor Schools 0.0 X Grant Program Safe and Drug-Free Schools, Part A, Subpart 441.0 X 1, State Grants for Drug and Violence Prevention School Dropout Demonstration Assistance 12.0 X Program Subtotal $482.5 Department of Health and Human Services (29 programs) Center for Substance Abuse 2.3 X Prevention—Public Education/Dissemination Community Prevention Coalitions Not available X Demonstration Grant Program Community Schools Youth Services and 10.0 X Supervision Program (continued) Page 12 GAO/T-HEHS-97-166 Appendix I Federal Substance-Abuse Prevention and Violence-Prevention Programs for Youths Dollars in millions Type of prevention assistance for which funds are available Estimate of federal Substance- funding for youths abuse Agency and program during FY 1995 prevention Violence prevention Both Demonstration Grant Program for Residential 2.0 X Treatment for Women and Their Children Demonstration Partnership Program 0.0 X Demonstration Programs for High Risk Youth 65.2 X Drug Abuse Prevention for Runaway and 14.5 X Homeless Youth Emergency Community Services Homeless Not available X Grant Program Family and Community Violence Prevention 5.9 X Program Family Support Center and Gateway 7.3 X Demonstration Programs Health Care for the Homeless Program Not available X Health Services for Residents of Public 9.5 X Housing Indian Health Service—Alcohol and 66.1 X Substance Abuse Programs Indian Youth Grant Program 0.5 X Injury Prevention and Control Research and 22.2 X State Grant Projects Maternal and Child Health Block Grant Not available X Services Program Maternal and Child Health Block Grant 3.4 X Services Program—Special Projects of Regional and National Significance Migrant Health Centers Not available X National Institute of Alcohol Abuse and 20.3 X Alcoholism—Research Programs National Institute on Drug Abuse—Research 6.0 X Programs National Youth Sports Program 12.0 X Native American Programs Not available X Runaway and Homeless Youth 40.5 X Programs—Basic Centers Service Grant Program for Residential 1.3 X Treatment for Pregnant and Postpartum Women Social Services Block Grant Not available X (continued) Page 13 GAO/T-HEHS-97-166 Appendix I Federal Substance-Abuse Prevention and Violence-Prevention Programs for Youths Dollars in millions Type of prevention assistance for which funds are available Estimate of federal Substance- funding for youths abuse Agency and program during FY 1995 prevention Violence prevention Both Substance Abuse Prevention and Treatment Not available X Block Grant Urban Indian Health Program 5.8 X Youth Initiatives/Youth Gangs 10.5 X Youth Risk Behavior Surveillance System 1.4 X Subtotal $306.7 Department of Housing and Urban Development (four programs) 4-H After-School Program/Demonstration 3.5 X Youth Apprenticeship 0.4 X Youth Development Initiative 10.0 X Youth Sports/Public and Indian Housing 13.9 X Drug Elimination Program Subtotal $27.8 Department of the Interior (one program) Indian Child Welfare Act (Title II Grants) 23.8 X Subtotal $23.8 Department of Justice (14 programs) Boot Camps, Part H 0.0 X Children’s Justice Act Discretionary Grants 0.0 X for Native American Indian Tribes Community Outreach Program 0.3 X Community Relations Service Initiatives 10.0 X Edward Byrne Memorial State and Local Law 28.8 X Enforcement Assistance Programs—Discretionary Grant Edward Byrne Memorial State and Local Law 48.5 X Enforcement Assistance Programs—Formula Grant Gang-Free Schools and 10.0 X Communities—Community-Based Gang Prevention Juvenile Justice and Delinquency 70.0 X Prevention—Allocation to States (State Formula Grants) Part B Juvenile Justice and Delinquency 4.0 X Prevention—Juvenile Mentoring, Part G (continued) Page 14 GAO/T-HEHS-97-166 Appendix I Federal Substance-Abuse Prevention and Violence-Prevention Programs for Youths Dollars in millions Type of prevention assistance for which funds are available Estimate of federal Substance- funding for youths abuse Agency and program during FY 1995 prevention Violence prevention Both Juvenile Justice and Delinquency Prevention 25.0 X National Programs—Discretionary Grants, Part C Public Education on Drug Abuse 0.7 X Title II: Part A—Concentration of Federal 0.2 X Efforts Title V—Incentive Grants for Local 20.0 X Delinquency Prevention Programs Weed and Seed Program Fund Not available X Subtotal $217.5 Department of Labor (one program) Job Training Partnership Act—Job Corps 1,099.5 X Subtotal $1,099.5 Department of Transportation (one program) Youth Impaired Driving Projects 1.4 X Subtotal $1.4 Department of Treasury (one program) Gang Resistance Education and Training 16.2 X Projects Subtotal $16.2 National Foundation on the Arts and Humanities (four programs) Promotion of the Arts—Arts for Youth 0.4 X Promotion of the Arts—Arts in Education-Art 5.8 X Corps Promotion of the Arts—Expansion Arts—Arts 0.3 X Education Initiative Promotion of the Arts—State and Regional 2.7 X Program Subtotal $9.2 President’s Crime Prevention Council (one program) President’s Crime Prevention Council 1.5 X Subtotal $1.5 Total $2,395.3 Page 15 GAO/T-HEHS-97-166 Related GAO Products The Government Performance and Results Act: 1997 Governmentwide Implementation Will Be Uneven (GAO/GGD-97-109, June 2, 1997). Substance Abuse and Mental Health: Reauthorization Issues Facing the Substance Abuse and Mental Health Services Administration (GAO/T-HEHS-97-135, May 22, 1997). Agencies’ Strategic Plans Under GPRA: Key Questions to Facilitate Congressional Review (GAO/GGD-10.1.16, May 1997). Drug Control: Observations on Elements of the Federal Drug Control Strategy (GAO/GGD-97-42, Mar. 14, 1997). Drug and Alcohol Abuse: Billions Spent Annually for Treatment and Prevention Activities (GAO/HEHS-97-12, Oct. 8, 1996). Executive Guide: Effectively Implementing the Government Performance and Results Act (GAO/GGD-96-118, June 1, 1996). At-Risk and Delinquent Youth: Multiple Federal Programs Raise Efficiency Questions (GAO/HEHS-96-34, Mar. 6, 1996). Managing for Results: Achieving GPRA’s Objectives Requires Strong Congressional Role (GAO/T-GGD-96-79, Mar. 6, 1996). School Safety: Promising Initiatives for Addressing School Violence (GAO/HEHS-95-106, Apr. 25, 1995). Drug Use Among Youth: No Simple Answers to Guide Prevention (GAO/HRD-94-24, Dec. 29, 1993). Adolescent Drug Use Prevention: Common Features of Promising Community Programs (GAO/PEMD-92-2, Jan. 16, 1992). Drug Education: School-Based Programs Seen as Useful but Impact Unknown (GAO/HRD-91-27, Nov. 28, 1990). (104894) Page 16 GAO/T-HEHS-97-166 Ordering Information The first copy of each GAO report and testimony is free. Additional copies are $2 each. Orders should be sent to the following address, accompanied by a check or money order made out to the Superintendent of Documents, when necessary. VISA and MasterCard credit cards are accepted, also. Orders for 100 or more copies to be mailed to a single address are discounted 25 percent. Orders by mail: U.S. General Accounting Office P.O. Box 6015 Gaithersburg, MD 20884-6015 or visit: Room 1100 700 4th St. NW (corner of 4th and G Sts. 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Substance Abuse and Violence Prevention: Multiple Youth Programs Raise Questions of Efficiency and Effectiveness
Published by the Government Accountability Office on 1997-06-24.
Below is a raw (and likely hideous) rendition of the original report. (PDF)