Consensus Study Report
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International Standard Book Number-13: 978-0-309-69753-8
International Standard Book Number-10: 0-309-69753-0
Digital Object Identifier: https://doi.org/10.17226/26831
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2023. Review of four CARA programs and preparing for future evaluations. Washington, DC: The National Academies Press. https://doi.org/10.17226/26831.
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COMMITTEE ON THE REVIEW OF SPECIFIC PROGRAMS IN THE COMPREHENSIVE ADDICTION AND RECOVERY ACT
KENNETH B. WELLS (Chair), Director, Center for Health Services and Society, Semel Institute, University of California, Los Angeles
HORTENSIA AMARO (Vice Chair), Distinguished University Professor and Senior Scholar on Community Health, Florida International University
GINA BRYAN, Director and Clinical Professor, Post Graduate Psych-Mental Health Program, University of Wisconsin–Madison
KAREN CROPSEY, Conaster Turner Endowed Professor of Psychiatry, The University of Alabama at Birmingham
MARCELA HORVITZ-LENNON, Senior Physician Scientist, RAND Corporation
SANDEEP KAPOOR, Assistant Professor, Medicine, Emergency Medicine, and Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
RAYMOND C. LOVE, Professor and Director, Mental Health Program, School of Pharmacy, University of Maryland
ROSALIE PACULA, Professor and Elizabeth Garrett Chair in Health Policy, Economics, and Law in the Sol Price School of Public Policy, University of Southern California
JOSÉ A. PAGÁN, Chair and Professor, Department of Public Health Policy and Management, New York University School of Global Public Health
SHARON REIF, Professor, Heller School for Social Policy and Management, Brandeis University
GERY RYAN, Professor, Health System Science, Kaiser Permanente Bernard J. Tyson School of Medicine
Study Staff
KATHLEEN STRATTON, Study Director
M. KELLY McHUGH, Associate Program Officer
CRYSTI PARK, Administrative Assistant
MISRAK DABI, Senior Financial Business Partner
ROSE MARIE MARTINEZ, Senior Board Director
CHRISTOPHER LAO-SCOTT, Senior Research Librarian
NAM Fellow
RUCHI FITZGERALD, Service Chief, Inpatient Addiction Medicine at PCC Community Wellness
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Reviewers
This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.
We thank the following individuals for their review of this report:
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report nor did they see the final draft before its re-
lease. The review of this report was overseen by JACK C. EBELER, member of NASEM Health and Medicine Division committee, and JOSIAH (JODY) D. RICH, Brown University. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.
Acknowledgments
The committee of this study thanks both the Substance Abuse and Mental Health Services Administration and the Comprehensive Addiction and Recovery Act grantees for their work and for providing information to the National Academies for this report series.
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Contents
Comprehensive Addiction and Recovery Act
Report Series Statement of Task
Interpretation of the Statement of Task
Assessing Effectiveness: Approach
Assessing CARA Programs: Streams of Information
Future Evaluation Mandates: Approach
Information Sources and Limitations
Findings: Partners and Network
Findings: Structural and Environmental Change
Information Sources and Limitations
Findings: Partners and Network
Findings: Structural and Environmental Change
Findings: Individual-Level Outcomes
Findings: Community-Level Outcomes
5 OD TREATMENT ACCESS FINDINGS
Information Sources and Limitations
Accomplishments: Grantee and Partner Activities
Accomplishments: Structural and Environmental Change
Barriers to Project Activities and Structural Change
Findings: Individual-Level Outcomes
Findings: Community-Level Outcomes
Information Sources and Limitations
Findings: Grantee and Partner Activities
Findings: Structural and Environmental Change
7 CONCLUSIONS ABOUT THE CARA PROGRAMS
Limits on Inferences About Program Effectiveness
8 PREPARING FOR FUTURE EVALUATIONS
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Acronyms and Abbreviations
BCOR | Building Communities of Recovery |
BRSS TACS | Bringing Recovery Supports to Scale Technical Assistance Center Strategy |
CAPTA | Child Abuse Prevention Treatment Act |
CARA | Comprehensive Addiction and Recovery Act |
CBA | cost-benefit analysis |
CDC | Centers for Disease Control and Prevention |
CEA | cost-effective analysis |
CSAP | Center for Substance Abuse Prevention |
CSAT | Center for Substance Abuse Treatment |
DSP-MRT | Division of State Programs Management Reporting Tool |
EMS | Emergency Medical Services |
EPIS | Exploration, Preparation, Implementation, Sustainment |
FDA | U.S. Food and Drug Administration |
FOA | Funding Opportunity Announcement |
FQHC | federally qualified health center |
FR | first responder |
FR-CARA | First Responder Training |
FY | fiscal year |
GAO | U.S. Government Accountability Office |
GPRA | Government Performance and Results Act |
HHS | U.S. Department of Health and Human Services |
MOUD | medications for opioid use disorder |
OD Treatment Access | Improving Access to Overdose Treatment |
OIG | Office of Inspector General |
OMB | Office of Management and Budget |
OUD | opioid use disorder |
PAF | Public Access File |
PPW | pregnant and postpartum women |
PPW-PLT | State Pilot Grant Program for Treatment for Pregnant and Postpartum Women |
QRT | Quick Response Team |
RCO | recovery community organization |
RSS | recovery support services |
SAMHSA | Substance Abuse and Mental Health Services Administration |
SBIRT | Screening, Brief Intervention, and Referral to Treatment |
SSA | State Agency for Substance Abuse |
SUD | substance use disorder |
TA | technical assistance |