Review of Four CARA Programs and Preparing for Future Evaluations (2023) / Chapter Skim
Currently Skimming:
Pages 104-121
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 104... ...
Additionally, efforts around the agency have been limited as many people have been home due to health conditions that put them at-risk to the pandemic. FR-CARA grantees reported that partnerships and grant progressions were heavily impacted by social distancing guidelines, lockdowns, individual safety, and resource constraints.
|
From page 105... ...
Another grantee noted that it was working to create a lawful and ethical way for information to be utilized in following up with overdose victims, with the potential of ensuring that an increasing the number of those with substance use disorder are connected to care, which would require multiple data sharing agreements and potentially an informed consent process. FINDINGS: OUTCOMES FR-CARA focused on trainings for naloxone distribution and strategies to reduce opioid overdose and deaths; these activities have, as potential outcomes, overdose reversals and prevention of death from overdose.
|
From page 106... ...
Note that the findings here reflect both FR-CARA and OD Treatment Access grantees. Below is information in their summary: Several CSAP grantees noted that "this [grant]
|
From page 107... ...
, grantees commented on the broader impact their CARA grant program could have on individual attitudes and public perception on overdose and recovery by highlighting the need within their community. NORC noted that grantees identified stigma among individuals administering overdose prevention medications (e.g., first responders, key community members)
|
From page 108... ...
NORC also identified data requests as a barrier for addressing stigma: NORC noted that grantees reported that those at risk of experiencing an overdose were less likely to receive overdose prevention medication kits if asked to complete documentation of any kind -- for example, asked for a name or demographics. More broadly NORC identified data gaps in having population impact information.
|
From page 109... ...
Sometimes it was possible to determine whether the grantee agency or partners were responsible for or involved in the structural and environmental changes; most often when these were reported, it was not possible from the available summaries and comments to determine the source of the changes instituted. Structural and environmental goals and impacts were primarily focused around expanding community partnerships or community agency roles, promoting policy change and advocacy or system regulation changes, addressing disparities for high-risk populations, and having the necessary data and support for these goals, and sometimes for sustainability.
|
From page 110... ...
The FR-CARA grant reported grant activities to the Prevention Task Force in March 2019. This suggests that this grantee worked to align broader goals of state policy leaders and some activities of the FR-CARA program.
|
From page 111... ...
One grantee noted: Law enforcement officers and firefighters without EMS certification must be licensed to carry and administer naloxone; Resource constraints and resistance among law enforcement officers to become licensed to carry and administer naloxone caused us to focus more on Fire and EMS agencies. Another noted: In the rural counties, the area's Law Enforcement and Fire/EMS authorities do not envision the Opiate Issue to be as bad and as the EMS departments currently already carry Naloxone from the hospital drug bag program (which contains Naloxone)
|
From page 112... ...
. Just as this example illustrates the use of data to help overcome barriers or develop support for implementing programs more broadly, other grantees noted that data are needed to convince policy makers to support sustainability; and one grantee noted particularly the importance of data to inform EMS (first responder)
|
From page 113... ...
The committee makes no conclusions about individual grantees or specific Comprehensive Addiction and Recovery Act (CARA) grant programs, nor does the committee make conclusions about "effectiveness in achieving their goals." As discussed in the second report in this series, none of the data the Substance Abuse and Mental Health Services Administration (SAMHSA)
|
From page 114... ...
. The outcomes data that the committee did receive were also at times not aligned with the goals of the program (e.g., the GPRA tool tracked long-term treatment outcomes that were appropriate for individuals who were in treatment, but not for the people being trained as recovery coaches for the BCOR program)
|
From page 115... ...
Given these challenges and that the grantees operated in a complex milieu of health care, public health, criminal justice, law enforcement, child welfare, employer, and community programs, 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.
|
From page 116... ...
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. Such recovery and wraparound services have been demonstrated to support recovery (Eddie et al., 2019; McLellan et al., 1999; Scott and Dennis, 2009; Stewart et al., 2021)
|
From page 117... ...
The FR-CARA grantees also used funds to perform naloxone distribution and training, which have been shown to 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)
|
From page 118... ...
By engaging in educational efforts with community members and with a wide variety of professionals, they also undertook efforts to improve knowledge about SUD treatment, recovery, and overdose reversal and to reduce stigma. Many grantees noted that the CARA funding allowed them to expand their services to additional clients or even additional population types (e.g., to expand services into rural areas)
|
From page 119... ...
CSAP grantees highlighted immediate benefits of partnerships such as connection to and buy-in from new audiences for their naloxone and coprescribing trainings, and facilitation of referrals of overdose survivors to supportive services or medical treatment; in the longer term, they expressed that these partnerships could increase communication among agencies and result in permanent and sustainable changes in systems-level protocols and processes related to the care of people with SUD. CSAT grantees highlighted similar immediate benefits to their partnerships -- they felt they increased referrals to their services from their partners and enabled the grantees to connect their clients more easily to a range of helpful services; in the longer term, they felt that their efforts to educate partners or build relationships with new entities likely spread community knowledge about SUD and reduced stigma.
|
From page 120... ...
SIGNIFICANT OBSTACLES The committee appreciates that grantees and SAMHSA staff operated throughout at least some of the programs' lifecycle under the extraordinary stress of the COVID-19 pandemic, which was concurrent with a deepening in the nation's crisis surrounding the opioid epidemic. The committee further appreciates that the four CARA programs, broad in scope as they were, were limited in what grantees and SAMHSA could address.
|
From page 121... ...
They described general shortages in their areas of particular types of staff and high turnover across the board. BCOR grantees described a particular challenge in retaining peer recovery coaches.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.