Review of Four CARA Programs and Preparing for Future Evaluations (2023) / Chapter Skim
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1 Introduction
1 Introduction
Pages 19-34
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; 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)
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. The CARA grant programs described in this report, while focused primarily on opioids, may also occasionally include treatment and recovery services for co-occurring SUDs.
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shall complete an evaluation of any program administered by the Secretary included in this Act (or an amendment made by this Act, excluding sections 703 through 707) , including any grant administered by the Administrator of the Substance Abuse and Mental Health Services Administration under section 103, that provides grants for the primary purpose of providing assistance in addressing problems pertaining to opi oid abuse based upon the outcomes and metrics identified under paragraph (2)
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. This provision authorizes HHS to award grants for supporting the development and expansion of recovery services.7 THE FOUR PROGRAMS Two of the Comprehensive Addiction and Recovery Act (CARA)
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help state substance abuse agencies address the continuum of care, including services provided to women in nonresidential-based settings; and 3) promote a coordinated, effective and efficient state system managed by state substance abuse agencies by encour aging new approaches and models of service delivery.
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The CSAP began accepting applications for the OD Treatment Access program in FY2017. The program aims to expand access to FDA-approved drugs or devices for the emergency treatment of opioid overdose.
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. The 48 total projects comprise a mix of recipient organizations: Native American tribes; emergency medical response service organizations; state, county, and local health departments; medical centers; health and wellness centers; municipalities; SUD treatment facilities; and a university.11 Grantees may receive funding for up to 4 years (SAMHSA, 2017c)
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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.
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• 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. • Develop policy to support needed services system improvements (e.g., rate-setting activities, establishment of standards of care, adherence to the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care, development/revision of credentialing, licensure, or accreditation requirements)
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. The information in the Awards and Projects column comes from the Individual Grant Awards pages for OD Treatment Access (SAMHSA, 2017f, 2018e)
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• Provide public education on any state ‘Good Samaritan' laws, such as those that permit bystanders to alert emergency responders to an overdose or to administer FDA-approved overdose reversal drugs without fear of civil or criminal penalties." Required Activities • "Make a drug or device approved or cleared under the Federal Food, Drug, and Cosmetic Act for emergency treatment of a known or suspected opioid overdose available to be carried and administered by first responders (FRs) and members of other key community sectors.
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. The specific CARA programs are Building Communities of Recovery; State Pilot Grant Program for Treatment for Pregnant and Postpartum Women; First Responder Training; and Improving Access to Overdose Treat ment.
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to recommend to Congress the appropriate distribution of resources for these and similar grant programs in the federal response to the opioid epidemic. INTERPRETATION OF THE STATEMENT OF TASK As presented in Chapter 1 of this report, the committee's charges for the third and final report, according to the Statement of Task, were twofold: 1.
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Due to these limitations, the committee again reiterates that it cannot conduct a true effectiveness evaluation of the four CARA programs, relative to other similar programs. However, the materials provided by SAMHSA were sufficient for the committee to describe, to some extent, the general experience and processes of the four grant programs.
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The committee suggested that a strategy to answering the third interpretation of the charge would consist of an analysis of "how, in the future, Congress can specify required evaluation methods and processes to assess program effectiveness and cost-benefit analysis, and how SAMHSA can improve program evaluation capacity and efforts in similar programs," which "would result in more robust evaluation assessment and information for decision makers responsible for guarding the public's health and related expenditure decisions" (NASEM, 2021)
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Still, it is the committee's hope that this report can be useful for other efforts to address SUD or reform reporting and evaluation requirements in grant programming. SUDs, including OUD, are relapsing or recurring15 disorders with a complex biopsychosocial etiology and are impacted by a range of social determinants, root causes, and policy factors; it is not the committee's expectation that any of these grant programs could fully address the challenges of OUD and SUD in communities where they exist.
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