Review of Four CARA Programs and Preparing for Future Evaluations (2023) / Chapter Skim
Currently Skimming:
7 Conclusions About the CARA Programs
7 Conclusions About the CARA Programs
Pages 113-124
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From page 113... ...
Nevertheless, as illustrated in the four previous chapters, the materials the committee reviewed included a great deal of description about the efforts and activities that grantees undertook using CARA funding, which hold promise as a step toward addressing the opioid use disorder epidemic. It is the committee's hope that the evidence it has highlighted and described in this report, though not a formal effectiveness evaluation, still highlights the hard work of SAMHSA and its grantees to confront an important public health challenge.
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From page 114... ...
For example, none of the CSAT reporting tools asked grantees to share information about partnerships developed, which was a central goal of both the Building Communities of Recovery (BCOR) and State Pilot Grant Program for Treatment for Pregnant and Postpartum Women (PPW-PLT)
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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.
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From page 116... ...
However, because the committee did not have enough information, it also cannot directly compare grantee efforts to this outside literature -- it could not, for example, assess for the suitability of an otherwise effective intervention to the specific populations in the catchment areas of the anonymized grantees, or otherwise analyze implementation. Nevertheless, the following paragraphs summarize some of the grantee activity accomplishments described for each of the four programs in the previous chapters.
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From page 117... ...
Several grantees used CARA funds to enhance their services by engaging peer support workers, or by training staff in evidencebased practices and particularly trauma-informed care relevant to the PPW patient population (Henry et al., 2021; Sperlich et al., 2017)
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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)
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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.
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From page 120... ...
Several of the challenges that grantees highlighted related to communication and management challenges with SAMHSA.1 In the NORC report, grantees referred to difficulty achieving program goals in light of the low funding levels and short implementation time frames. They also noted that in some cases there were delays in budget approval, and a lack of communication with Grant Program Officers (in part due to turnover on SAMHSA's end during the grant period)
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From page 121... ...
As previously mentioned, many of the challenges in data collection cited by CSAT program grantees revolved around the difficulties with the GPRA tool and what they described as unrealistic follow-up target rates set by SAMHSA. CSAP grantees cited difficulties with non-response on follow-up surveys from training participants.
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From page 122... ...
Perhaps most obviously, many in-person services -- trainings for CSAP grantees and BCOR, and treatment and recovery services provision for BCOR and PPW-PLT -- were halted due to stay-at-home orders. BCOR grantees noted that social distancing was especially troubling for recovery programs, which are heavily focused on interpersonal connection.
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From page 123... ...
Finally, broader trends in funding availability and sustainability were a challenge for grantees. Grantees noted challenges brought about by a lack of funding sources and opportunities for SUD work, or the short time frames of soft money opportunities that are often the most available to organizations doing this type of work.
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