Barry W. Lovgren PO Box 6744 Gardnerville, NV (775) July 26, 2016

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1 Barry W. Lovgren PO Box 6744 Gardnerville, NV (775) July 26, 2016 Nevada Department of Health and Human Services Attn: Richard Whitley, Director 4126 Technology Way, Suite 100 Carson City, NV Dear Mr. Whitley: The purpose of this letter is to ask that you please only sign the assurances given in the course of obtaining Substance Abuse Prevention and Treatment (SAPT) Block Grant funding for federal fiscal year 2017 if the assurances are, in fact, being kept. At present they are not. Sometime before October 1 you will be asked to sign assurance that Nevada complies with the requirements for receiving this funding, including those relating to services for injection drug users (42 USC 300x-23), services for pregnant women (42 USC 300x-27), and needs assessment (42 USC 300x-29). I trust that you will not knowingly submit a false or misleading official report by signing assurance that they are being met when they are not [c.f. NRS ]. To give such false assurance would be to impugn the integrity and credibility of the Division, betray the trust Governor Sandoval placed in you when he gave you authority to sign on his behalf, and possibly place Nevada s continued receipt of SAPT Block Grant funding at risk. The enclosed April 26 letter to SAPTA outlines the specifics of how Nevada fails to comply with the regulations implementing 42 USC 300x-23, 42 USC 300x-27, and 42 USC 300x-29. That letter concludes, Ignoring these regulations has resulted in the agency charged with meeting Nevada s needs for substance abuse services expending funding to meet those needs without finding out just what those needs are. Ignoring these regulations has exacerbated the plight of Nevada s heroin addicts, the plight of Nevada s pregnant women who abuse alcohol or other drugs, and the plight of babies born to women who abused alcohol or other drugs during pregnancy. You may recall our having met after I had found in 2009 that the number of pregnant women receiving substance abuse treatment had fallen by half with no corresponding decrease in the number of pregnancies in Nevada and with no evidence of a corresponding decrease in the rate of substance abuse among pregnant women. I ascribed

2 much of this decline to noncompliance with federal requirements for SAPT Block Grant funding. The decline persists. I continue to ascribe much of the decline to noncompliance with requirements for SAPT Block Grant funding. Addendum 1 is the text of the relevant sections of Federal statute and of the regulations implementing them. Addendum 2 is suggested ways of attaining compliance. I m pleased to note that the specific noncompliance I then was primarily focused upon, the failure of Nevada to publicize the availability of substance abuse treatment and admission priority at funded treatment programs (45 CFR (b)) has been remedied: SAPTA and the Bureau of Child, Family, and Community Wellness have partnered in a public education campaign to publicize this While October 1 may seem like a very short time-frame to attain compliance with 42 USC 300x-23, 42 USC 300x-27, and 42 USC 300x-29 and with the regulations implementing these sections of federal statute, Nevada has had since the establishment of these requirements in 1993 to attain it. I trust that you will sign assurance that Nevada is in compliance with these federal laws only if Nevada is in compliance. Thank you, Barry W. Lovgren cc: enc: Governor Brian Sandoval Nevada Legislative Committee on Health Care John Campbell, Chief, Performance Partnership Branch, SAMHSA Teresa Mitchell, Project Officer, Center for Substance Abuse Treatment Cody Phinney, Administrator, DPBH Julia Peek, Deputy Administrator, DPBH Kevin Devine, Interim Bureau Chief, SAPTA April 26, 2016, letter to SAPTA Addendum 1: Applicable Federal Statute and Regulation Addendum 2: Suggested Compliance Methods

3 Barry W. Lovgren PO Box 6744 Gardnerville, NV (775) April 26, 2016 Substance Abuse Prevention and Treatment Agency (SAPTA) Attn: Kevin Quint, Director 4126 Technology Way, Second Floor Carson City, NV Dear Mr. Quint: Despite the rather unfortunate tone of this letter, I do wish to acknowledge the very hard work you ve done since becoming SAPTA Chief. The problems outlined in this letter are only part of the problems you inherited when you became Chief. SAPTA was in very poor shape then, and, as they say, Rome wasn t built in a day. But it really is time to fix these problems. This is being written with the hope you ll take advantage of opportunities to fix problems with SAPTA s implementation of the millions of federal dollars in Substance Abuse Prevention and Treatment Block Grant funds. These problems could place Nevada s continued receipt of these funds at risk and they certainly impede treatment of injection drug abusers and of pregnant women who abuse alcohol or other drugs. There have been numerous missed opportunities to remedy these problems. But there still are opportunities which need not be missed: The conditions of subgrant award of Block Grant funds to programs can be revised for the upcoming funding cycle; missing required elements of the State Plan in the Block Grant application and missing reports required to accompany the application can be submitted to SAMHSA as attachments to application. In December 2014 the Substance Abuse and Mental Health Services Administration s (SAMHSA s) Center for Substance Abuse Treatment (CSAT) conducted a Block Grant compliance monitor of SAPTA. That monitor found that SAPTA had failed to implement the required capacity management and waiting list management system which is to facilitate timely admission of injection drug abusers and of pregnant women to substance abuse treatment, and to ensure the provision of interim services when timely admission isn t possible. The monitor also noted that SAPTA had failed to conduct the required assessment of substance abuse service needs. Without needs assessment, adequate planning is impossible. While the state suffers from a well-publicized epidemic of heroin addiction, SAPTA s continuing failure to have a capacity and waiting list management system to facilitate treatment of injection drug abusers doesn t just violate federal regulation. It violates

4 common sense. SAPTA s continuing failure to prevent Fetal Alcohol Syndrome and other substancerelated birth defects by establishing a capacity and waiting list management system to facilitate treatment of pregnant women doesn t just violate federal regulation. It violates simple human decency. Subsequent to the monitor review, SAPTA expended taxpayers money on a 128-page document entitled, Nevada Substance Abuse, Mental Health and Suicide Prevention Needs Assessment Report This document was submitted to the Behavioral Health Planning and Advisory Council for its Block Grant planning meeting. While federal regulation requires that the State s needs assessment accompany the Block Grant application, the document submitted to the Council for Block Grant planning is so woefully inadequate to federal minimum requirements that it remains the only document from the planning meeting which has not been submitted with the application. It appears that SAPTA doesn t want SAMHSA to know about the document, nor about the expense of having it prepared: In response to an application revision request from SAMHSA, SAPTA explained the absence of a needs assessment accompanying the application with, It became apparent that the expenditure of additional resources did not need to occur in data gathering and analysis. Instead, Nevada utilized meta-analysis methodology The resulting report and identified gaps and priorities are attached to this response. While the gaps analysis indeed was attached, the purported needs assessment was not. The federal monitor didn t point out that SAPTA doesn t meet the federal mandate to require funded programs to report when 90% of capacity to treat injection drug users has been met, nor that SAPTA doesn t meet the federal mandate to require funded programs to contact SAPTA when the program is unable to admit a pregnant woman. These two mandates are the foundation of the requisite capacity and waiting list management system. The monitor did point out that the reason given by SAPTA for its failure to have a capacity and waiting list management system is problems with its Electronic Health Records (EHR) system. Those problems continue, and SAPTA continues to not have a capacity and waiting list management system. What the monitor did not point out is that SAPTA need not rely upon an EHR system for this in the first place. The regulation requiring a capacity and waiting list management system was adopted in 1993, long before EHR systems existed: The Bureau of Alcohol and Drug Abuse, SAPTA s predecessor agency, maintained its capacity and waiting list management system through telephone contact with the programs. Finally, the monitor didn t point out that SAPTA doesn t comply with the mandate that it require programs providing treatment to injection drug abusers - which is every treatment program SAPTA funds - to conduct outreach encouraging injection drug abusers to obtain treatment. SAPTA doesn t require the programs to conduct such outreach at all,

5 let alone conduct outreach adequate to the federal requirements. That programs funded to treat injection drug users aren t conducting outreach to them while Nevada suffers from a well-publicized heroin epidemic is simply absurd. The core problem here is that SAMHSA doesn t enforce its own regulations. In its application instructions SAMHSA failed to ask for required elements of the Block Grant application in which SAPTA is to specify how it will maintain a capacity and waiting list management system and to report on how it s done this. SAMHSA failed to ask for the required elements of the application in which SAPTA is to specify how it will ensure that there is outreach to injection drug abusers and to report on how it s done this. In the application instructions SAMHSA fails to ask for the needs assessment which is required to be part of the State Plan. While SAMHSA failed to ask for these required elements of the application, they still can be submitted as supplemental attachments. While SAPTA certainly can continue ignore SAMHSA s regulations since SAMHSA itself appears to ignore them, I m hoping that SAPTA will comply with the regulations on its own initiative. Ignoring these regulations has resulted in the agency charged with meeting Nevada s needs for substance abuse services expending funding to meet those needs without finding out just what those needs are. Ignoring these regulations has exacerbated the plight of Nevada s heroin addicts, the plight of Nevada s pregnant women who abuse alcohol or other drugs, and the plight of babies born to women who abused alcohol or other drugs during pregnancy. Sincerely, Barry W. Lovgren cc: Julia Peek, Deputy Administrator, Division of Public and Behavioral Health Cody Phinney, Administrator, Division of Public and Behavioral Health John Campbell, Chief, Performance Partnership Grant Branch, Substance Abuse and Mental Health Services Administration

6 Addendum 1: Applicable Federal Statute and Regulation Injection Drug Users Statute: 42 USC, Section 300x-23 Intravenous substance abuse (a) Capacity of treatment programs (1) Notification of reaching capacity A funding agreement for a grant under section 300x-21 of this title is that the State involved will, in the case of programs of treatment for intravenous drug abuse, require that any such program receiving amounts from the grant, upon reaching 90 percent of its capacity to admit individuals to the program, provide to the State a notification of such fact. (2) Provision of treatment A funding agreement for a grant under section 300x-21 of this title is that the State involved will, with respect to notifications under paragraph (1), ensure that each individual who requests and is in need of treatment for intravenous drug abuse is admitted to a program of such treatment not later than (A) 14 days after making the request for admission to such a program; or (B) 120 days after the date of such request, if no such program has the capacity to admit the individual on the date of such request and if interim services are made available to the individual not later than 48 hours after such request. (b) Outreach regarding intravenous substance abuse A funding agreement for a grant under section 300x-21 of this title is that the State involved, in providing amounts from the grant to any entity for treatment services for intravenous drug abuse, will require the entity to carry out activities to encourage individuals in need of such treatment to undergo treatment. Regulation: 45 CFR, Part 96, Section 126 Capacity of treatment for intravenous substance abusers (a) In order to obtain Block Grant funds, the State must require programs that receive funding under the grant and that treat individuals for intravenous substance abuse to provide to the State, upon reaching 90 percent of its capacity to admit individuals to the program, a notification of that fact within seven days. In carrying out this section, the State shall establish a capacity management system which reasonably implements this section that is, which enables any such program to readily report to the State when it reaches 90 percent of its capacity and which ensures the maintenance of a continually updated record of all such reports and which excess capacity information available to such programs. (b) In order to obtain Block Grant funds, the State shall ensure that each individual

7 (c) (d) (e) who requests and is in need of treatment for intravenous drug abuse is admitted to a program of such treatment not later than (1) 14 days after making the request for admission to such a program; or (2) 120 days after the date of such request, if no such program has the capacity to admit the individual on the date of such request and if interim services, including referral for prenatal care, are made available to the individual not later than 48 hours after such request. In carrying out subsection (b), the State shall establish a waiting list management program which provides systematic reporting of treatment demand. The State shall require any program receiving funding from the grant, for the purposes of treating injection drug abusers, establish a waiting list that includes a unique patient identifier for each injecting drug abuser seeking treatment including those receiving interim services, while awaiting admission to such treatment. For individuals who cannot be placed in comprehensive treatment within 14 days, the State shall ensure that the program provide such individuals interim services as defined in section and ensure that the programs develop a mechanism for maintaining contact with the individuals awaiting admission. The States shall also ensure that the programs consult the capacity management system as provided in paragraph (a) of this section so that patients on waiting lists are admitted at the earliest possible time to a program providing such treatment within reasonable geographic area. In carrying out paragraph (b)(2) of this section the State shall ensure that all individuals who request treatment and who can not be placed in comprehensive treatment within 14 days, are enrolled in interim services and those who remain active on a waiting list in accordance with paragraph (c) of this section, are admitted to a treatment program within 120 days. If a person cannot be located for admission into treatment or, if a person refuses treatment, such persons may be taken off the waiting list and need not be provided treatment within 120 days. For example, if such persons request treatment later, and space is not available, they are to be provided interim services, placed on a waiting list and admitted to a treatment program within 120 days of the latter request. The State shall require that any entity that receives funding for treatment services for intravenous drug abuse carry out activities to encourage individuals in need of such treatment to undergo such treatment. The States shall require that any entity that receives funding for treatment services for intravenous drug abuse carry out activities to encourage individuals in need of such treatment to undergo such treatment. The States shall require such entities to use outreach models that are scientifically sound, or if no such models are available which are applicable to the local situation, to use an approach which reasonably can be expected to be an effective outreach method. The model shall require that outreach efforts include the following: (1) Selecting, training, and supervising outreach workers; (2) Contacting, communicating and following-up with high risk substance abusers, their associates, and neighborhood residents, within the constraints of Federal and State confidentiality requirements, including 42 CFR, part 2;

8 (f) (3) Promoting awareness among injecting drug abusers about the relationship between injecting drug abuse and communicable diseases such as HIV; (4) Recommend steps that can be taken to ensure that HIV transmission does not occur; and (5) Encouraging entry into treatment. The State shall develop effective strategies for monitoring programs compliance with this section. States shall report under the requirements of section (g) on the specific strategies to be used to identify compliance problems and corrective actions to be taken to address those problems. Pregnant Women Statute: 42 USC, Section 300x-27 Treatment services for pregnant women (a) In general A funding agreement for a grant under section 300x-21 of this title is that the State involved (1) will ensure that each pregnant woman in the State who seeks or is referred for and would benefit from such services is given preference in admission to treatment facilities receiving funds pursuant to the grant; and (2) will, in carrying out paragraph (1), publicize the availability to such women of services from the facilities and the fact that the women receive such preference. (b) Referrals regarding States A funding agreement for a grant under section 300x-21 of this title is that, in carrying out subsection (a)(1) of this section (1) the State involved will require that, in the event that a treatment facility has insufficient capacity to provide treatment services to any woman described in such subsection who seeks the services from the facility, the facility refer the woman to the State; and (2) the State, in the case of each woman for whom a referral under paragraph (1) is made to the State (A) will refer the woman to a treatment facility that has the capacity to provide treatment services to the woman; or (B) will, if no treatment facility has the capacity to admit the woman, make interim services available to the woman not later than 48 hours after the woman seeks the treatment services. Regulation: 45 CFR, Part 96, Section 131 Treatment services for pregnant women. (a) The State is required to, in accordance with this section, ensure that each pregnant woman in the State who seeks or is referred for and would benefit from such services is given preference in admissions to treatment facilities receiving funds

9 pursuan to the grant. In carrying out this section, the State shall require all entities that serve women and who receive such funds to provide preference to pregnant women. Programs which serve an injecting drug abuse population and who receive Block Grant funds shall give preference to treatment as follows: (1) Pregnant injecting drug users; (2) Pregnant substance abusers; (3) Injecting drug users; and (4) All others. (b) The State will, in carrying out this provision publicize the availability to such women of services from the facilities and the fact that pregnant women receive such preference. This may be done by means of street outreach programs, ongoing public services announcements (radio/television), regular advertisements in local/regional print media, posters placed in targeted areas, and frequent notification of availability of such treatment distributed to the network of community based organizations, health care providers, and social service agencies. (c) The State shall in carrying out paragraph (a) of this section require that, in the event that a treatment facility has insufficient capacity to provide treatment services to any such pregnant woman who seeks services from the facility, the facility refer the woman to the State. This may be accomplished by establishing a capacity management system, utilizing a toll-free number, an automated reporting system and/or other mechanisms to ensure that pregnant women in need of such services are referred as appropriate. The State shall maintain a continually updated system to identify treatment capacity for any such pregnant women and will establish a mechanism for matching the women in need of such services with a treatment facility that has the capacity to treat the woman. (d) The State, in the case of each pregnant woman for whom a referral under paragraph (a) of this section is made to the State (1) will refer the woman to a treatment facility that has the capacity to provide treatment services to the woman; or (2) will, if no treatment facility has the capacity to admit the woman, make available interim services, including a referral for prenatal care, available to the woman not later than 48 hours after the woman seeks the treatment services. (e) Procedures for the implementation of this section shall be developed in consultation with the State Medical Director for Substance Abuse Services. (f) The State shall develop effective strategies for monitoring programs compliance with this section. States shall report under the requirements of section (g) on the specific strategies to be used to identify compliance problems and corrective actions to be taken to address those problems. Statute: 42 USC, Section 300x-29 Needs Assessment

10 Submission to Secretary of statewide assessment of needs The Secretary may make a grant under section 300x-21 of this title only if the State submits to the Secretary an assessment of the need in the State for authorized activities (which assessment is conducted in accordance with criteria issued by the Secretary), both by locality and by the State in general, which assessment includes a description of (1) the incidence and prevalence in the State of drug abuse and the incidence and prevalence in the State of alcohol abuse and alcoholism; (2) current prevention and treatment activities in the State; (3) the need of the State for technical assistance to carry out such activities; (4) efforts by the State to improve such activities; and (5) the extent to which the availability of such services is insufficient to meet the needs for the activities, the interim services to be made available under sections 300x-23(a) and 300x-27(b) of this title, and the manner in which such services are to be so available. Regulation 45 CFR, Part 96, Section 133 Submission to Secretary of Statewide assessment of needs. (a) The State is required to submit to the Secretary an assessment of the need in the State for authorized activities, both by locality and by the State in general. The State is to provide a broad range of information which includes the following: (1) The State is to submit data which shows the incidence and prevalence in the State of drug abuse and the incidence and prevalence in the State of alcohol abuse and alcoholism. For fiscal years 1993 through 1996, the State shall submit its best available data on the incidence and prevalence of drug and alcohol abuse and alcoholism. The State shall also provide a summary describing the weakenss and bias in the data and a description on how the State plans to strengthen the data in the future. (2) The State shall provide a description on current substance abuse prevention and treatment activities: (i) For fiscal year 1994 and subsequent years, the State shall provide a detailed description on current prevention and treatment activities in the State. This report shall include a detailed description of the intended use of the funds relating to prevention and treatment, as well as a description of treatment capacity. As to primary prevention activities, the activities must be broken down by strategies used, such as those provided in section , including the specific activities conducted. The State shall provide the following data if available: The specific risk factors being addressed by activity; the age, race/ethnicity and gender of the population being targeted by the prevention activity, and the community size and type where the activity is carried out. As to all treatment and prevention activities, including primary prevention, the State shall provide the identities of the entities that provide the services and describe the services provided. The State shall submit information on treatment utilization

11 to describe the type of care and the utilization according to primary diagnosis of alcohol or drug abuse, or a dual diagnosis of drug and alcohol abuse. (3) The State may describe the need for technical assistance to carry out Block Grant activities, including activities relating to the collection of incidence and prevalence data identified in paragraph (a)(1) of this section. (4) The State shall establish goals and objective for improving substance abuse treatment and prevention activities and shall report activities taken in support of these goals and objectives in its application. (5) The State shall submit a detailed description on the extent to which the availability of prevention and treatment activities is insufficient to meet the need for activities, the interim services to be made available under sections and , and the manner in which such services are to be so available. Special attention should be provided to the following groups: (i) Pregnant addicts; (ii) (iii) Women who are addicted and who have dependent children; Injecting drug addicts; and substance abusers infected with HIV or who have tuberculosis. (6) Documentation describing the results of the State s management information system pertaining to capacity and waiting lists shall also be submitted, as well as a summary of such information for admissions and, when available, discharges. As to prevention activities, the report shall include a description of the populations at risk of becoming substance abusers.

12 Addendum 2: Suggested Compliance Methods 1. In addition to requirements currently established by conditions of award/subgrant scope of work, amend requirements to include that a funded treatment program which serves injection drug users must: Notify SAPTA within seven (7) days of reaching 90 percent of its capacity to admit individuals; Admit a person seeking treatment for injection drug use within 14 days of the request for treatment*; or, provide interim services which include: - Counseling and education about HIV and tuberculosis; - Counseling and education about the risks of needle-sharing; - Counseling and education about the risks of transmission to sexual partners and infants; - Counseling and education about steps that can be taken to ensure that HIV and TB transmission doesn t occur; - Any necessary referral for HIV or TB treatment. Admit a person seeking treatment for injection drug use within 120 days of the request for treatment*. [Interim services must be provided if the person cannot be admitted within 14 days of the request for treatment*.] Participate in SAPTA s capacity-management/waiting-list management system to ensure that all persons who request treatment for injection drug use and who cannot be admitted to treatment are maintained on a waiting list, are provided interim services if the person cannot be admitted to treatment within 14 days, and are admitted to a treatment program within 120 days. Conduct outreach to injection drug users in the community utilizing a scientifically sound outreach model, or, if no such models are applicable to the community, utilize a model which can be reasonably expected to be effective. The model utilized must include: - Selecting, training and supervising outreach workers; - Contacting, communicating, and following up with high-risk substance abusers, their associates, and neighborhood residents within the constraints of Federal and State confidentiality requirements; - Promoting awareness among injecting drug abusers about the relationship between injection drug abuse and communicable diseases such as HIV; - Recommending steps that can be taken to ensure that HIV transmission does not occur; and - Encouraging entry into treatment. [42 USC, Section 300x-23; 45 CFR, ; 45 CFR, ]

13 2. In addition to requirements currently established by conditions of award/subgrant scope of work amend requirements to include that a funded treatment program serving women must: If the program cannot admit a pregnant woman seeking treatment from the facility, refer the woman to SAPTA. If referral of the woman to SAPTA as described above does not result in the woman being admitted to treatment, no later than 48 hours after her request for treatment* the program must make available to her interim services which include: - Counseling on the effects of alcohol and drug abuse upon the fetus; and - Referral to prenatal care. [42 USC, 300x-27; 45 CFR, ] 3. Amend the instrument used by SAPTA to monitor funded treatment programs for compliance with conditions of award/subgrant scope of work requirements to include monitoring the programs for compliance with #1 and #2, above. [42 USC, 300x-23; 42 USC, 300x-27; 45 CFR, ; 45 CFR, ; 45 CFR, ] 4. Amend the SAPTA Waiting List Management policy (Appendix F5) to provide for the elements of #1 and #2, above. [42 USC, 300x-23; 42 USC, 300x-27; 45 CFR, ; 45 CFR, ; 45 CFR, ] 5. Establish a functional waiting list/capacity management system which provides for: - SAPTA to readily identify which programs are at or above 90% of capacity; - SAPTA to readily identify which programs can admit a pregnant woman or an injection drug user who is seeking treatment; - SAPTA to monitor programs for compliance with waiting list and interim services requirements. [42 USC, 300x-23; 42 USC, 300x-27; 45 CFR, ; 45 CFR, ] This need not be based upon an Electronic Health Records (EHR) system. A system based upon telephonic and/or communication between SAPTA and funded treatment programs could be utilized pending implementation of an EHR system which provides for a functional waiting list/capacity management system.] 6. In the course of developing those elements of items 2 through 5, inclusive, which address compliance with 45 CFR , obtain consultation from the State Medical Director for Substance Abuse Services.

14 [45 CFR (e)] 7. Amend the SAPT Block Grant application to include in its State Plan the strategies to be used to identify problems with implementation of the requirements for services for injection drug users specified in 45 CFR and to problems with implementation of the requirements for services for pregnant women specified in 45 CFR , and to report on the corrective actions to be taken to correct those problems. [45 CFR (g); 45 CFR (f); (f)] 8. Conduct, and submit to SAMHSA, a substance abuse services needs assessment which meets the requirements of 45 CFR to the best of the current ability of SAPTA. This may be essentially an interim report, with a better report to be submitted after SAPTA has developed the capability to better assess substance abuse needs. For example, until SAPTA has implemented a functional capacity and waiting list management system (c.f. #5, above) it won t be possible to include in the needs assessment data from such a system as required by 45 CFR (6). Some requirements can readily be met. For example, SAPTA already has an online listing of substance abuse service resources funded by SAPTA. Using this listing would remedy the breathtaking inaccuracy of the resource listing in the Nevada Substance Abuse, Mental Health and Suicide Prevention Needs Assessment Report 2015 which lists the Carson City Justice/Municipal Court which provides no behavioral health services - as the provider of 28 behavioral health services, such as Clinically Managed Inpatient Substance Abuse. WestCare, the largest funded substance abuse service provider in Nevada, isn t listed at all. SAPTA can utilize what data is currently available regarding the incidence and prevalence of substance abuse in Nevada and note, pursuant to 45 CFR (a)(1), weaknesses in the data and plans for strengthening it, while noting pursuant to 45 CFR (a)(3) any need for technical assistance in strengthening the data. * Some perhaps all - SAPTA-funded programs measure this not from the date of the person requesting services, but of the date of the person having received a clinical evaluation determining that he or she is in need of services. This besides violating Federal law has resulted in such anomalies as a pregnant woman seeking substance abuse treatment being scheduled for a clinical evaluation after she had delivered the child and in the meantime not being carried on the program s waiting list nor provided interim services. For lack of a functional capacity management system, SAPTA was unable to determine which, if any, program could admit her to treatment. It was only because of the efforts of the woman s very persistent probation officer that she obtained treatment prior to the birth of her child.