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Title page 1

Contents 3

Highlights 2

Letter 5

Background 9

SAMHSA Programs and Activities 9

Selected SAMHSA Grant Programs 10

SAMHSA's Role During the COVID-19 Pandemic 12

Grant Flexibilities Available During COVID-19 14

Advisory Councils and Policy Lab Provided Advice and Resources to Support SAMHSA's COVID-19 Response 16

Advisory Council Advice Related to COVID-19 16

Policy Lab Support During the COVID-19 Pandemic 23

Selected SAMHSA Awardees Made Various Changes to Service Delivery During the COVID-19 Pandemic Amid Challenges Such as Workforce Hiring and Retention 26

Selected Awardees Increased Telehealth to Maintain Services and Expanded Some Services to Address COVID-19 Needs 26

Selected Awardees Experienced Workforce Hiring and Retention and Telehealth Implementation Challenges That Affected Service Delivery 33

SAMHSA Provided Technical Assistance and Grant Administration and Program Flexibilities to Support Awardees During the COVID-19 Pandemic 37

Technical Assistance 37

Grant Administration and Program Flexibilities 41

Agency Comments 51

Appendix I: Objectives, Scope and Methodology 52

Appendix II: Summary of Selected SAMHSA Grant Programs During COVID-19 56

Appendix III: Selected Grant Administration Flexibilities Allowed by SAMHSA During the COVID-19 Pandemic 59

Appendix IV: GAO Contact and Staff Acknowledgments 61

Tables 3

Table 1. Selected Flexibilities Related to SAMHSA Awardees' Program Implementation During and After the COVID-19 Pandemic 47

Table 2. Summary of Selected SAMHSA Grant Programs That Supported Behavioral Health Services During the COVID-19 Pandemic, Fiscal Years 2020-2023 57

Table 3. Overview of Selected Grant Administration Flexibilities Allowed by SAMHSA During the COVID-19 Pandemic 59

Figures 4

Figure 1. SAMHSA Advisory Councils and Focus Areas During the COVID-19 Pandemic, January 2020-May 2023 17

Figure 2. SAMHSA Policy Lab Considerations for Using Telehealth to Treat Serious Mental Illness and Substance Use Disorder 24

Figure 3. Examples of Selected State and Provider Awardees' Changes to Behavioral Health Services During the COVID-19 Pandemic 27

Figure 4. Examples of Locations for Behavioral Health Staff and Clients to Connect Through Telehealth 29

Figure 5. Example SAMHSA Resource-Wallet Card on Managing Stress During the COVID-19 Pandemic, Published July 2020 41

Figure 6. Number of SAMHSA Awardees That Received Project Period Extensions for Block Grant COVID-19 Supplemental Funding 43