Review of Four CARA Programs and Preparing for Future Evaluations (2023) / Chapter Skim
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Appendix B: Contracted NORC Report
Appendix B: Contracted NORC Report
Pages 155-202
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Appendix B Contracted NORC Report 155
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APPENDIX B 157 FINAL REPORT September 2022 Review of Specific Programs in the Comprehensive Addiction and Recovery Act Presented by: Presented to: NORC at the University of Chicago The National Academies of Sciences, Mithuna Srinivasan, PhD Engineering, and Medicine Susan Cahn, PhD 500 Fifth Street, NW Christina Drymon, PhD Washington, DC 20001 Jennifer Norris, MPH Farah Sublett, MPH
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173 Grant Evaluation Process ...................................................................................................... 177 Grant Program Impacts and Sustainability ............................................................................
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168 Exhibit 5: SAMHSA-funded CARA Grant Program Goals .........................................................
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Thus far, NASEM individual, semi-structured research has resulted in two reports. For the third and final interviews with individuals report, NASEM seeks to understand the factors that impede from grantee organizations or facilitate the implementation and the evaluation of four that participated in the implementation and/or the specific SAMHSA-funded CARA grant programs to support evaluation of one of the four NASEM toward making conclusions about the effectiveness SAMHSA-funded CARA grant of achieving program goals and recommendations to programs awarded in FY2017 Congress for the future of the federal government's response or FY2018.
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o Transitioning care successfully from in-person to virtual during the COVID-19 pandemic, leading to cost savings and expansion of people who could attend trainings and receive services. • Grantees encountered several challenges while implementing their CARA grant programs, including: o Several CSAT grantees and one CSAP grantee attributed delayed program start-up due to SAMHSA funding delays.
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. Identifying additional funds to cover the cost of overdose prevention medications, however, was seen as a bigger hurdle for CSAP grantees.
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were commissioned to convene an expert Committee to issue a series of three reports over five years evaluating the success of four specific grant programs funded and administered by the Substance Abuse and Mental Health Services Administration (SAMHSA)
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Specifically, the interviews gathered information to address the following research objectives: • The goals of implementing grantees, and how they fit within the stated goals of the SAMHSA funded CARA grant programs; • The process of implementing each grantee organization's SAMHSA-funded CARA grant program, and factors contributing to successes and challenges; • How each grantee organization evaluated its SAMHSA-funded CARA grant program, with a specific focus on the types of data collected related to process and outcome metrics; • The intended and unintended impacts of the grantee organization's SAMHSA-funded CARA grant program on the population served, organizations involved, and the broader community, and assess any efforts related to program sustainability; and • Grantee recommendations for future programs and evaluations. Report Purpose and Structure This report presents findings from an analysis of interviews with program administrators at grantee organizations implementing and/or evaluating SAMHSA-funded CARA programs.
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Methodological Approach and Data Collection As previously noted, the study's goal is to supplement information previously reported to SAMHSA on the progress of CARA grant programs. To accomplish this goal, NORC was tasked with conducting individual, semi-structured interviews with program administrators at grantee organizations that had participated in the implementation and/or the evaluation of one of the four SAMHSA-funded CARA grant programs (i.e., FR-CARA, BCOR, PPW-PLT, and OD Tx; see Exhibit 1 for a brief description of each program)
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. NORC received from NASEM a list of grantee 1 For a more detailed description of the required and allowable activities of the CARA grant programs, please see: FR-CARA Funding Opportunity Announcement SP-17-005.
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BCOR grantees included recovery community organizations. Exhibit 2: Population of SAMHSA-funded CARA Grantees, by Program CARA Program Universe of Grantees Selected for Interview Recruitment FR-CARA 48 19 BCOR 26 14 PPW-PLT 6 6 OD Tx 6 6 TOTAL 86 45 Recruitment of Selected Interviewees.
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within the SAMHSA-funded CARA grant program and grantee organization • Involvement in the SAMHSA CARA grant proposal Grant Program Goals • Goals of each SAMHSA-funded CARA grant program • How program goals fit within the broader goals of the grantee organization Grant Implementation Process • Identification of key successes and challenges encountered while FINAL REPORT | SEPTEMBER 2022
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The consent to record was also documented in the interview notes. Video recordings were destroyed immediately following the completion of the interviews, however, any notes, audio recordings, and transcripts used by the NORC study team to develop the final report will be destroyed following the conclusion of the Committee's work on June 30, 2023.
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Additionally, grantees were told during the outreach process that they did not need to prepare anything before the discussion, however, if they felt that they might want to refresh their memory about a few program details, they were welcome to do so. That said, there was no requirement for grantees to bring copies of their original proposals, work plans, evaluation plans, progress reports, or final report to the interview or review them prior.
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About half of the participants had either developed or written the CARA grant proposal. Regardless of title, tenure, or involvement in the proposal, all interview participants were knowledgeable about their grant program and able to speak to the broad set of discussion topics identified in the initial outreach email (see Appendix A)
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. For further discussion on the impact the SAMHSA-funded CARA grants had on grantees' ability to create new partnerships and sustain existing ones, see the Grant Implementation Process section.
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. The grant programs noted that the CARA grant funding has been fantastic for that .
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grantees identified partnerships as a success more often than the remaining two programs, which is consistent with their grant program goals. The second most commonly reported success was the impact organizations had on reducing stigma in their communities.
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While several grantees were successful at reducing stigma within their communities, it remained a challenge for other grantees across the CSAP and CSAT programs. Grantees identified stigma among individuals administering overdose prevention medications (e.g., first FINAL REPORT | SEPTEMBER 2022
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Additionally, treatment organizations external to CARA grant programs were not always willing to share data due to Health Insurance Portability and Accountability Act (HIPAA) privacy concerns, while other partnering organizations found it difficult to share data elements beyond those available in their EHR system.
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Grant Evaluation Process "COVID-19 was a major challenge. We had a drop in face-to-face contact, and then, you know, some of the terminology that we use, I mean it was for good Grantee evaluation efforts focused mostly on intentions but it kind of, you know, social distancing.
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their CARA grant program. One CSAT grantee had a very positive reaction to the web reporting tools and felt the information collected told "a good story about what was going on with each [client]
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Grant Program Impacts and Sustainability Grantees were asked to discuss the perceived impacts of their SAMHSA-funded CARA grant programs and their plans for program sustainability. In general, all grantees believed they were able to achieve at least some of their program goals.
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. Some examples of key impacts that were identified included: • Many grantees across CSAP and CSAT programs noted that meeting and/or exceeding the requirements of the SAMHSA-funded CARA grant program and the original targets grantees had set for themselves (see Grant Implementation Process section for "Yeah, numbers are low, but our quality was more on this)
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additional funds to cover the cost of overdose prevention medications was seen as a bigger hurdle for CSAP grantees. Some grantees are considering changes to their organization and workflow to be more sustainable in the absence of CARA grant funds.
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A few BCOR grantees mentioned that they would like the requirement for matching funds dropped. Although matching funds were not required by all SAMHSA-funded CARA grant programs, among those that did have this requirement (BCOR grant programs)
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The goal of this work was to support NASEM and the Committee's efforts in making recommendations to Congress about the future of the federal government's response to the opioid crisis. For this study, NORC conducted semi-structured interviews with 22 grantee organizations that participated in the implementation and/or evaluation of one of the four SAMHSA-funded CARA grant programs awarded in FY2017 or FY2018.
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However, it is important to note that in several instances securing SAMHSA funding gave grantees the credibility, clout, and confidence to persist in the face of entrenched stigma. The CARA grant program requirements supported grantees in making considerable inroads in their communities to change attitudes and perceptions about individuals experiencing overdose and/or in recovery.
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. Measuring Success in Substance Use Grant Programs: Outcomes and Metrics for Improvement.
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-funded Comprehensive Addiction and Recovery Act (CARA) grant programs to reduce opioid-related harm and promote recovery from substance use disorders.
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We look forward to hearing from you! Best, The NORC Study Team Follow-Up Interview Email for PI/co-PI as Respondent Subject Line: Invitation to Participate in a Confidential Discussion for a Study Related to SAMHSA-funded CARA Grant Programs Hello [PI/Co-PI Name]
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Thank you, The NORC Study Team Follow-Up Interview Email for Other Program Team Member Subject Line: Invitation to Participate in a Confidential Discussion for a Study Related to SAMHSA-funded CARA Grant Programs Hello [Study Staff Name] , CC: PI/co-PI The National Academies of Sciences, Engineering, and Medicine (the ‘National Academies')
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All interview responses will be kept confidential and stored separately from contact information, and all such data will be stored on a highly secure and encrypted server at NORC. NORC will not share contact information or interview responses with anyone outside our Study Team.
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-funded Comprehensive Addiction and Recovery Act (CARA) grant programs to reduce opioid-related harm and promote recovery from substance use disorders.
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As noted above, all interview responses will be kept confidential and stored separately from contact information, and all such data will be stored on a highly secure and encrypted server at NORC. Video recordings (if applicable)
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NORC will prepare a report of findings for submission to the National Academies in July 2022. In that report, all findings will only represent aggregate opinions across interviewees so that none of the findings will be attributed to individuals, and re-identification of individual respondents would not be possible by either the National Academies or SAMHSA.
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Rather, we are interested in hearing about your organization/agency's insights and experiences with implementing and evaluating your CARA grant program, that can supplement any prior reporting to SAMHSA on the progress of your CARA grant program. Your participation will help to ensure that the National Academies' recommendations to Congress are responsive to the experiences of CARA grantees.
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grant program impacts and sustainability, and (5) recommendations for future policy and programming.
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a) What kinds of specific targets, if any, did the SAMHSA CARA grant program hope to achieve?
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did the goals of your organization/agency change? Section 2: Grant Implementation Process Now we're going to move into the second section of the interview, which focuses on the process of implementing your organization/agency's SAMHSA CARA grant program.
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, etc., to document and manage client needs, care processes, integration with related support services, and outcomes. - Train or develop the workforce to help state staff or community provider employees to identify mental health or substance abuse or provide effective services consistent with the purpose of the grant program.
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a) To what extent does the required web-based reporting capture the successes, achievements, and activities of your SAMHSA CARA grant program?
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* Does your organization/agency systematically track how your SAMHSA CARA grant program has been impacting your community?
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* What were some of the unanticipated or unique impacts of the SAMHSA CARA grant program, both positive and negative?
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18) In order to help the federal government more effectively prioritize and allocate future funding to help address opioid misuse, overdose, and other substance misuse, can you describe the types or areas of future funding that would be most beneficial to your organization/agency?
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