Infrastructure Change Is Not Enough: An Evaluation of SAMHSA’s Mental Health Transformation State Incentive Grants

Objective

The authors evaluated the Substance Abuse and Mental Health Services Administration’s mental health transformation state incentive grant program, which provided more than $100 million to nine states to make infrastructure changes designed to improve services and outcomes.

Methods

The authors measured infrastructure changes, service changes, and consumer outcomes in the nine programs. Although the federal program had no logic model, the authors adopted a model that hypothesized positive, but small, correlations between the program elements.

Results

There were few statistically significant correlations and a number of negative correlations between infrastructure changes, service changes, and consumer outcomes.

Conclusions

Federal investments should take into account evidence that infrastructure changes alone do not necessarily contribute to better consumer outcomes, support operationally defined infrastructure improvements, require that service improvements accompany infrastructure changes, and provide sufficient resources to oversee grantee behaviors. In addition, future evaluation should support evaluation best practices.