In a sudden move that took many industry stakeholders by surprise, the Trump administration last month ended the National Registry of Evidence-Based Programs and Practices (NREPP), a database of more than 400 resources and programs geared toward the prevention and treatment of substance abuse and mental illnesses.
The Substance Abuse and Mental Health Services Administration (SAMHSA), which funded NREPP, confirmed to ThinkProgress in a statement that the registry’s current contract was discontinued.
NREPP began in 1997 and had since been remodeled to include treatment interventions. Some of the recent programs added to the registry — which is still online, but hasn’t been updated since September — included a recovery and support group program for opioid addiction, a depression prevention intervention program, a substance abuse prevention program aimed at middle school students, and a therapy program for Puerto Rican teenagers suffering from depression.
SAMHSA maintained that its Policy Lab will take over for the registry and help in “identifying and disseminating evidence-based practice and programs.” But that’s where things become unclear, said Grove City College psychology professor Warren Throckmorton, who has been following the issue closely and first reported the NREPP’s closure in a blog post last week. While SAMHSA mentions its intention to move evidence-based practices under the jurisdiction of its Policy Lab, it does not specify how it intends to do so.
“In the past, SAMHSA’s not had adequate staffing,” Throckmorton told ThinkProgress. He added that during the Obama administration, the agency hired contractors to oversee the evaluation of NREPP programs. “What is different now? How is SAMHSA going to do that in house? What internal resources have they committed?” Throckmorton asked.
Those contractors, the Development Services Group, Inc. (DSG), were taken by surprise when they were informed last month of the decision to terminate funding for the program. According to an email obtained by Throckmorton, DSG notified program participants that NREPP was terminated “for the convenience of the government.”
“We are deeply saddened by the government’s sudden decision to end the NREPP contract, under which we have been able to provide and strengthen science-based information about mental health and substance use treatment and prevention programs, both nationally and internationally,” the DSG email read, according to Throckmorton.
The government informed DSG of the decision to terminate funding several months after it instructed DSG to freeze the registry’s work in September.
“It took them from September to December just to tell them funding was terminated,” Throckmorton said. “So now what?”
Throckmorton speculated that the decision to terminate the registry likely came from a desire to streamline bureaucracy after the implementation of the 21st Century Cures Act, enacted in 2016. Under the law, the government is required to provide information about working treatments of mental illness and substance abuse. By shifting the jurisdiction to SAMHSA’s Policy Lab, the Trump administration is seemingly still abiding by the law, but the transition has been disjointed, leaving many providers with unanswered questions about the continuation of their programs.
“We’re several days into this and the provider community still doesn’t know how the evidence-based portion of the Cures Act will be implemented,” Throckmorton said. “They don’t know how to update their programs … As of now, they don’t know what to do with their results.”
He added that SAMHSA failed to provide reasons for the shift, nor has it alerted program participants who rely on the registry.
“It looks, unfortunately, like a typical government approach,” Throckmorton said. “If the transition isn’t well thought out, what assurance do I have that the implementation will be?”
Christine Moutier, chief medical officer of the American Foundation for Suicide Prevention, a non-profit that has used the NREPP database, said the decision to terminate the registry came as a shock to her organization. Without NREPP, Moutier said, there is no other federally-operated database of suicide prevention programs that also conducts review processes for those programs. Because of NREPP, she added, most states now have laws requiring teacher training and student education on suicide prevention. That type of standard-setting is “now gone,” she said.
“One of our goals, our vision … is to see more federal support of suicide prevention,” Moutier told ThinkProgress. “Treat suicide like the top 10 leading cause of death that it is.”
Moutier said her organization has reached out to SAMHSA for additional information, but has not heard back.
“That would have been the more proactive approach to have been given some lead in to these changes occurring,” she said.
The decision to halt the registry comes weeks after the Trump administration advised the Centers for Disease Control and Prevention (CDC) not to use certain words in documents for the 2019 budget, including “evidence-based.” In a letter submitted to Democratic senators on Tuesday, CDC Director Brenda Fitzgerald said the suggestions were “not official Administration policy.”
“We get that [the decision to terminate the registry] could be for a whole host of reasons that we’re not privy to,” Moutier said. But in order to advance the goal in reducing suicide, “it shouldn’t be just on the private industry to make these changes occur.”
UPDATE: SAMHSA Assistant Secretary Elinore F. McCance-Katz released a statement on Thursday noting that the registry was ended because of the “flawed nature of this system.” The public statement came more than two weeks after funding for the registry was terminated, and did not address why program participants and providers were not forewarned about the termination.