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Pages 74-93

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From page 74...
... Selected services relevant to the PPW-PLT program goals include: • Screening and assessment º Screening: 50 percent of reporting clients º Assessment: 61 percent of reporting clients • Treatment º Brief interventions: 23 percent of reporting clients º Brief treatment: 20 percent of reporting clients º Medical services: 13 percent of reporting clients º Pharmacological intervention: 7 percent of reporting clients º Peer coaching or mentoring: 60 percent of reporting clients • Case management and related services º Case management: 88 percent of clients of reporting clients º Family services: 42 percent of reporting clients º Transportation: 35 percent of reporting clients º Pre-employment or employment coaching: 22 percent of re porting clients • Substance abuse education5: 53 percent of reporting clients • Information and referral: 32 percent of reporting clients 5  The committee notes that it prefers the term "substance use" and is reflecting the lan guage used in the GPRA tool.
From page 75...
... While some of these barriers were seen to affect the other CARA programs, such as the COVID-19 pandemic, systemic and policy barriers were frequently highlighted in the PPW-PLT grantee reports. COVID-19 Pandemic Though both cohorts of PPW-PLT grantees began their work prior to the beginning of the COVID-19 pandemic, their implementation periods did overlap with the pandemic.
From page 76...
... In the NORC interviews, some highlighted unexpected benefits, such as cost-savings conferred by virtual services, and a broader client reach. However, in progress reports, grantees noted specific barriers to the implementation and delivery of tele-services for the participants in the following settings: • participants living in rural settings, • incarcerated women living in criminal justice settings, • enrolled participants who did not have stable housing, • enrolled participants experiencing homelessness, • enrolled participants at risk of losing telephone access, and • enrolled participants who had to prioritize working or caring for their children over SUD treatment.
From page 77...
... Systemic and Policy Barriers PPW-PLT grantees consistently identified lack of recovery housing and suitable transitional housing for PPW clients/families as a barrier for service delivery in achieving PPW-PLT program goals. Grantee reports indicated that many clients did not have any housing options available to them that were viable long term during the time they were participating in the grantees' programming; housing options were particularly limited for PPW clients living in rural areas.
From page 78...
... Grantees wrote in progress reports that it was difficult to retain clients in treatment if they were not actively parenting their children, and that if a client were to lose custody of their child, often there was little motivation to stay enrolled in services. In addition, it was noted that some child welfare agency workers were accustomed to only residential-level services for this population and did not find outpatient-level service programs appropriate to meet child welfare service plan requirements.8 SAMHSA and Grant Management Grantees cited a number of challenges that the grant management presented to carrying out activities and services.
From page 79...
... The NORC interviews underscored a number of challenges that grantees identified in implementing the GPRA data collection tool. Some grantees felt that the tool: • did not "capture the full story of the program" • focused on follow-up rates over quality of care provided • created unnecessary administrative burden • focused on follow-up rates that might lead grantees to "cherry pick clients that are more likely to follow up" FINDINGS: PARTNERS AND NETWORK Effective partnerships and networks, as with other CARA programs, were noted to play an instrumental role in grantee implementation of the PPW-PLT program.
From page 80...
... Partnerships with Community Organizations All PPW-PLT grantees described, in both progress reports and the NORC interviews, forming partnerships with community organizations. Benefits of these partnerships were cited by grantees as essential and included dissemination to the community of information about the grantee's services; improved access for PPW clients to resources for basic needs (e.g., diapers, wipes, food pantries)
From page 81...
... Several grantees engaged in efforts to promote cross-sector collaboration, which the committee notes has the potential to effect structural and policy change for the PPW population by moving toward authentic collaboration between single state agencies administering PPW programs and child welfare agencies. Such efforts took several forms.
From page 82...
... Some grantees reported that child welfare caseworkers began to refer to their services as part of a family's plan of safe care or other types of indicated SUD treatment. This suggested that the two state agencies were moving toward higher levels of collaboration with that system for the benefit of the PPW population.
From page 83...
... Stigma reduction efforts through crosssector efforts (e.g., among single state agencies administering SUD treatment, child welfare agencies, and public health department) would also be necessary to impact population- and patient-level outcomes, improve treatment services, and increase access to housing and employment opportunities for PPW clients.
From page 84...
... The grantee progress reports and NORC interviews described several difficulties grantees faced in using the GPRA data system. These shed light on some of the potential causes of grantees' low follow-up rates (51.1% at 6 months, below the 80% follow-up goal laid out by the grant [P1a, P4a]
From page 85...
... . As such, the committee was not able to use the GPRA outcomes data to draw conclusions about the effectiveness of these grantees or of the PPW-PLT program overall in impacting individual outcomes.
From page 86...
... The discharge data SAMHSA provided were similarly limited; the committee received such data for only a small portion of the clients with intakes and does not have criteria for the different discharge status (which may have varied across grantees) , rendering it difficult for the committee to interpret the data.
From page 87...
... PROGRAM PURPOSE Title I, Prevention and Education, Section 107: Improving Access to Overdose Treatment Program (OD Treatment Access) of the Comprehensive Addiction and Recovery Act allows the U.S.
From page 88...
... The committee received anonymized data from SAMHSA submitted by grantees through the Division of State Programs Management Reporting Tool (DSP-MRT) reporting system.3 Most of the information provided comprised the free text submission in response to specific modules from the DSP-MRT.
From page 89...
... The most impressive accomplishments were those activities that went beyond best practices for use of opioid reversal agents and affected treatment. The grantees also faced challenges in their activities that are identified in a separate section below.
From page 90...
... For example, several partners reported adding therapists, case managers, and other staff to their partner organizations to facilitate training and distribution of opioid overdose reversal interventions. Another grantee reported using patient navigators to engage patients receiving medications for opioid use disorder (MOUD)
From page 91...
... As such, these changes have potential to reduce the risk of overdose in the future. Creation of Toolkits and Presentations As a primary aim of the grant, grantees and/or partners developed training programs regarding best practices related to opioid reversal agents.
From page 92...
... Examples of specific structural and environmental changes, by way of partnerships, reported by grantees include addition of a case worker to the police department, adding a member to the drug court team, engaging the assistance of medical and social work students, designation of points of contact with law enforcement, and creation of a new Overdose Treatment Access Collaborative to address critical service gaps. While one grantee reported developing a pharmacy "detailing" program, another reported building a cross-systems coordination among pharmacies, medical providers, behavioral health, community service entities, hospitals, emergency departments, and justice entities.
From page 93...
... BARRIERS TO PROJECT ACTIVITIES AND STRUCTURAL CHANGE The grantees faced multiple challenges in the development and implementation of their projects, which impacted grantee and partner activities, as well as efforts to create structural change. Source material for this section can be found in the online appendix [O1a and b]


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