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From page 1... ... ; this trend has continued (SAMHSA, 2021) .1 COMPREHENSIVE ADDICTION AND RECOVERY ACT To help address the challenges of overdose deaths and opioid use disorder and to expand access to evidence-based treatment, the Comprehensive Addiction and Recovery Act (CARA; P.L. Read the entire page →
From page 2... ... . THE FOUR CARA PROGRAMS Two of the CARA grant programs -- the State Pilot Grant Program for Treatment for Pregnant and Postpartum Women (PPW-PLT) Read the entire page →
From page 3... ... The committee's Statement of Task is in Box S-1. In the first report, the committee reviewed the reporting metrics selected by SAMHSA for the four CARA grant programs, and recommended changes or additions. Read the entire page →
From page 4... ... performance including services provided to women assessment. in nonresidential-based settings; and Up to 3 promote a coordinated, effective and years A minimum of efficient state system managed by 75% of federal state substance abuse agencies by funds must encouraging new approaches and be directed models of service delivery." toward service provision; no Through this program, SAMHSA seeks more than 25% to "reduce the misuse of alcohol and may go toward other drugs, increase engagement in infrastructure or treatment services, increase retention in capacity building. Read the entire page →
From page 5... ... ; it should identify gaps in services furnished to pregnant and postpartum women along the continuum of care with a primary diagnosis of substance use disorder, including opioid use disorders. • Develop and implement a state strategic plan or enhance an existing plan to ensure sustained partnerships across public health and other systems that will result in short and long-term strategies to support family-based treatment services along the continuum of care for pregnant and postpartum women." Allowable Activities • "Adopt and/or enhance computer system, management information system (MIS) Read the entire page →
From page 6... ... . The information in the Awards and Projects column comes from the Individual Grant Awards pages for OD Treatment Access (SAMHSA, 2017f, 2018e) Read the entire page →
From page 7... ... • Train and provide resources for FRs and members of other key community sectors on carrying and administering such a drug or device. • Establish processes, protocols, and mechanisms for referral to appropriate treatment and recovery communities, which may include an outreach coordinator or team to connect individuals receiving opioid overdose reversal drugs to follow-up services. Read the entire page →
From page 8... ... Assessing Effectiveness For the present report, SAMHSA provided similar information to what was provided for the second report for the CSAT programs. The agency supplied the committee with additional detail and free text responses from the CSAP program grantees mandatory reporting. Read the entire page →
From page 9... ... Nevertheless, it notes some instances in which grantee plans were rooted in interventions that have potential to be effective. BCOR grantees primarily provided two main types of direct services: recovery support services and wraparound to individuals with SUDs, and training to individuals seeking to work as peer recovery coaches. Read the entire page →
From page 10... ... The FR-CARA grantees also used funds to perform naloxone distribution and training, which have been shown to be effective and cost-effective in reducing overdose events (CDC, 2018b; Chao and Loshak, 2019; Chimbar and Moleta, 2018; Coffin and Sullivan, 2013; McClellan et al., 2018; Naumann et al., 2019; NIDA, 2017; Townsend et al., 2020) Read the entire page →
From page 11... ... Given these challenges and that the programs operated in a complex milieu of health care, public health, criminal justice, law enforcement, child welfare, and employer and community programs, and often across broad geographic areas, the committee cannot attribute some reported outcomes specifically to CARA programs. Finally, other considerations such as timing of the evaluation, details of the data sharing agreements between SAMHSA and grantees, and level of SAMHSA support to grantees for evaluation purposes from the outset precluded a rigorous evaluation of program effectiveness. Read the entire page →
From page 12... ... CONCLUSION 3: CARA funding supported grantees in enhancing or expanding treatment and recovery support services, as well as naloxone delivery. Grantees facilitated the education and training of community members and professionals about substance use disorder, stigma reduc tion, and overdose reversals. Read the entire page →
From page 13... ... The CARA grant programs were not intended to address most of these barriers. The first of this set of conclusions pertains to general barriers to implementation that were cross-cutting across the four programs; the next two highlight individually the two biggest barriers. Read the entire page →
From page 14... ... The committee notes that for programs such as these to reach their full potential to positively impact individuals and communities, they must be accompanied by structural and systems change through policy change at local, state, and national levels. PREPARING FOR FUTURE EVALUATIONS Over the past 5 years, the committee has reviewed the four CARA programs and the information that SAMHSA and its grantees have supplied. Read the entire page →
From page 15... ... Additionally, SAMHSA contracted with the National Academies to perform the review of the programs more than 1 year after Funding Opportunity Announcements were issued for the cohorts under study, mandatory reporting tools were selected and in use, and grantees had already 9 Throughout this chapter and report, "program" is used to refer to an overarching federal grant programs (e.g., one of the four CARA programs) , rather than to a project conducted by one of the grantees of those programs. Read the entire page →
From page 16... ... . It also allows time for the implementing agency and evaluator to set any necessary data sharing agreements, and to communicate those with grantees as applicable. Read the entire page →
From page 17... ... Should Congress decide to reauthorize the CARA programs and open SAMHSA funding to additional cohorts of grantees, setting them up with these recommendations in mind could enable a more useful evaluation of those cohorts and of the programs overall to inform policy. 12 In 2003, GAO highlighted the importance of "evaluation culture" to the success of evaluation strategies in five federal agencies. Read the entire page →
From page 18... ... Further, the committee hopes that the guidance it provided regarding future evaluations -- either of future cohorts of the CARA programs or of other federally funded programs -- will allow Congress to better understand the impact of its investments. The committee appreciates the opportunity to work with Congress, SAMHSA, and grantees. Read the entire page →
From page 19... ... ; this trend has continued (SAMHSA, 2021) .1 COMPREHENSIVE ADDICTION AND RECOVERY ACT To help address the challenges of overdose deaths and opioid use disorder and to expand access to evidence-based treatment, the Comprehensive 1 The text in this paragraph is reprinted from the second report in this series, updated with more recent data where available (NASEM, 2021) Read the entire page →

From page 1...

... ; this trend has continued (SAMHSA, 2021) .1 COMPREHENSIVE ADDICTION AND RECOVERY ACT To help address the challenges of overdose deaths and opioid use disorder and to expand access to evidence-based treatment, the Comprehensive Addiction and Recovery Act (CARA; P.L.