Review of Four CARA Programs and Preparing for Future Evaluations (2023) / Chapter Skim
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3 BCOR Findings
3 BCOR Findings
Pages 49-68
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From page 49... ...
as well as promotion of and education about recovery."1 1 Though BCOR is a new grant program, the committee notes that recovery support services are not a new construct for the Substance Abuse and Mental Health Services Administration (SAMHSA) funding; the agency has previously funded a program that shares similar goals, called the Recovery Community Services Program.
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The committee reached out to grantees directly and requested comprehensive progress reports or most recent progress reports, as available. Five BCOR grantees submitted these reports.
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Partnership Building Many grantees aimed to build or improve their partnerships with organizations in their communities, counties, or even states. In the NORC interviews, when asked to comment on the successes of the grant program, many CARA grantees across the four programs highlighted building and strengthening partnerships; the report stated that this was especially true of BCOR grantees.
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. Some grantees provided wraparound or ancillary services to meet the needs of their clients in recovery, including clinical case management, social 6 The committee notes that not all BCOR grantees provided those services directly (e.g., some trained peer support counselors who would later provide such services)
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In progress reports, grantees noted that the switch to virtual or hybrid services in some cases also increased their reach in terms of target population and geographic service area. This point was echoed in the NORC interviews, with one grantee commenting that the switch to virtual services also brought cost savings.
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Selected services provided by BCOR grantees include: • Core BCOR services º Assessment: 87 percent of reporting clients º Case management: 90 percent of reporting clients º Recovery support services: 79 percent of reporting clients • Other recovery support services º Treatment or recovery planning: 54 percent of reporting clients 9 prevention: 35 percent of reporting clients º Relapse º Recovery coaching: 37 percent of reporting clients º Peer coaching or mentoring: 26 percent of reporting clients º Other peer to peer recovery support services: 9 percent of re porting clients • Formal treatment º Group counseling: 69 percent of reporting clients º Individual counseling: 14 percent of reporting clients • Informal treatment º Self-help and other support groups: 24 percent of reporting clients º Spiritual support: 23 percent of reporting clients The committee notes that assessment, case management, and recovery support services are the core activities expected under the header of recovery support services that the BCOR grant aimed to fund, and are generally evidence-based (Bassuk et al., 2016; Eddie et al., 2019; Humphreys and McLellan, 2011; McLellan et al., 1999)
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. The committee cannot comment on whether these demographic breakdowns are representative of grantee communities or represent steps toward addressing disparities in access to services, because it does not know which grantees are reflected in the GPRA data SAMHSA shared, and because the intake data are aggregated across all grantees.
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Several grantees participated in the development of resources of value to the broader community. One collaborated with others in the state to create a statewide public resource for finding SUD treatment and recovery services, with an emphasis on "recovery assets." Another created an instant online access to an up-to-date local list of recovery support meetings, recovery supports including clinical treatment, and ancillary supports important to recovery.
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At the same time, grantees noted that transitions to virtual services and social distancing were a detriment since in-person contact is quite important for relationship building during recovery. NORC interviews echoed the fact that this was a challenge for BCOR grantees, given that recovery programs are about personal connection.
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In the NORC interviews, CSAT grantees highlighted funding delays, which affected ability to start up the grantee activities in a timely manner, inconsistent or nonexistent communication with SAMHSA Government Program Officers, short implementation periods, and the challenge of the funds matching requirement for the BCOR program specifically. Additionally, in the NORC interviews, CSAT grantees raised concerns related to reporting and GPRA data collection.
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The suitability of the GPRA tool for the BCOR program is discussed in more detail in the "Individual-Level Outcomes" section of this chapter. FINDINGS: PARTNERS AND NETWORK A required activity of CARA BCOR grantees was to "support the development, expansion and enhancement of community and statewide recovery support services." An allowable activity included a priority on developing sustainable infrastructure through partnerships with community and state organizations.
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One grantee was able to "unite existing local recovery supports to build and sustain a coordinated recovery-oriented system of care" through these mechanisms. Another spent the first year of their grant building a qualified peer recovery coach workforce, then worked with policy makers in the state Medicaid office to set standardized training for reimbursement, implemented this, and succeeded in becoming one of the only state-certified training resources for recovery organizations billing to Medicaid.
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Some grantees suggested that teaming with law enforcement made the treatment environment less of a supportive environment for clients, and furthered the narrative that people in recovery have more contact with law enforcement for punitive reasons, despite the grantees' goal of improving knowledge and reducing stigma across law enforcement. FINDINGS: STRUCTURAL AND ENVIRONMENTAL CHANGE This section focuses on grantee activities aimed at strengthening and maintaining the intervention well past the end of the grant, for example, ensuring programming sustainability or advocating for policies with eventual payoffs for the recovery community.
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Efforts to Secure Funding Past the End of the Grant Many grantees reported various efforts to secure additional funding both concurrent with the grant, and in order to ensure the viability of grantfunded activities past the end of the grant. This was echoed in the NORC interviews, in which several grantees across the CARA programs reported they were "applying for additional federal, state and/or local funding to maintain internal supports (e.g., staff)
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. Among them, one grantee reported participation in SAMHSA's Bringing Recovery Supports to Scale Technical Assistance Center Strategy (BRSS TACS)
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First, several of the BCOR grantees only trained recovery coaches (six grantees) or provided wraparound services to people in treatment (three grantees)
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In the NORC report, CSAT grantees reported trying to provide client incentives and gift cards as one strategy to addressing low follow-up rates, though the committee notes that it does not have enough information to confirm whether such strategies increased follow-up rates. Given all of these selection and measurement issues represented in the GPRA data, the committee determined these data were insufficient for drawing any conclusions regarding the effectiveness of the BCOR program on individual outcomes.
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. The lack of more salient measures of successful recovery on the GPRA forms led several grantees to report additional measures -- beyond those reported using the GPRA tools -- in their final progress reports, including information on participants' self-efficacy, recovery capital, and stigma.
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From page 67... ...
These efforts may have long-run impacts on individual and community outcomes in the future. Community knowledge about SUD and recovery services could be impacted by the consistent reporting of community-wide public education activities, trainings with law enforcement and/ or county jails, and partnerships with local medical centers and emergency departments from many of the grantees.
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