Review of Four CARA Programs and Preparing for Future Evaluations (2023) / Chapter Skim
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4 PPW-PLT Findings
4 PPW-PLT Findings
Pages 69-86
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Committee conclusions are presented in Chapter 7. PROGRAM PURPOSE Pregnant and postpartum women face significant barriers in locating treatment services that offer comprehensive substance use disorder (SUD)
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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 committee reached out to grantees directly and requested comprehensive progress reports or most recent progress reports, as available. SAMHSA then submitted redacted progress reports from the remaining grantees.
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Engagement of Peer Support Workers In progress reports, several grantees reported on the addition of peer support workers in their programming. Peer support workers' activities ranged from advocacy at the client level for obtaining resources; linking clients to community organizations and resources, including Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
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Services Provided to Individuals with SUD This section presents some of the data grantees reported, via the GPRA tool, about client characteristics and service provision. For a more detailed discussion of the limitations of this tool, refer to Chapter 2.
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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.
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; according to these data, 50 percent of reporting clients received screening and 61 percent assessment. It is unclear to the committee what might explain these numbers [P3a]
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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.
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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.
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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.
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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.
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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)
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These grantees used peer service workers in their service delivery, and detailed, in progress reports, their work in establishing partnerships with community-based organizations. Coordination Between Child Welfare System and SUD Treatment System All the PPW-PLT grantees noted in their progress reports that their clients were either involved in, or at risk of, child welfare involvement.
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As highlighted previously, examples grantees noted in progress reports included the use of SAMHSA's TA program to lead a statewide training to establish a set of standards for gender-based SUD treatment, called Family Centered Treatment, and Project CARA, a partnership that included a wide variety of stakeholders, and also used 9 The committee notes that implementation of compliance with CAPTA policies has varied widely (Lloyd et al., 2019)
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Despite the establishment of services, grantees noted how external factors continue to negatively influence treatment outcomes. Upon review of the grantee reports and the NORC interviews, structural factors such as the criminal justice system, the child welfare systems, the lack of available and affordable housing, the stigma of addiction, and the geographic distribution of services were all identified as key barriers to grantees' goals of supporting families affected by SUD, as described in this chapter's section under grantee activities, titled "Systemic and Policy Barriers." The overall health and well-being of families affected by SUD is heavily influenced by systems, as described above.
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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]
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. 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.
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Further, the committee cannot determine whether that was an appropriate length of stay without more details on clients' progress in treatment, the recommended length of treatment of relevant modalities, and the grantees' imposed limitations on length of stay. The committee also notes that treatment mandated by child services or the criminal justice system may have length of stay requirements, which could vary by grantee state, and was not noted in the GPRA data.
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