Review of Four CARA Programs and Preparing for Future Evaluations (2023) / Chapter Skim
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6 FR-CARA Findings
6 FR-CARA Findings
Pages 97-112
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From page 97... ...
The findings are organized by the framework developed by the committee, as described in Chapter 2, including grantee and partner activities, outcomes at the individual and community levels, and environmental and structural change efforts. The program purpose and the information sources reviewed by the committee are summarized below.
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From page 98... ...
However, because the committee often did not have enough information about grantee contexts, it also cannot directly compare grantee efforts to this outside literature or directly extrapolate inferences about grantee effec 1 SeeBox A-4 in Appendix A for a complete list of FR-CARA grantees. 2 Text in this section is reprinted from the second report in this series (NASEM, 2021)
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From page 99... ...
These needs assessments used many different sources of data (e.g., surveys, overdose data) , and many of them were conducted in close collaboration with law enforcement and emergency medical services (EMS)
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From page 100... ...
Some grantees reported using pre- and post-survey results regarding training about stigma and overdose training, and using pre- and post-survey results and focus groups to understand overdose reversals and improve training. One grantee noted that 13 participants filled out the class evaluation, and all participants (100%)
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From page 101... ...
Partnerships varied in terms of the number and types of organizations, including key organizations and sectors such as corrections, courts, harm reduction programs, social services organizations, pharmacies, recovery community organizations, shelters, substance use disorder treatment entities, and syringe exchange programs. In line with the grant objectives, partnerships were solidified in order to reach the target population with services and naloxone distribution.
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From page 102... ...
Other key data limitations included an underdeveloped infrastructure to monitor treatment admissions, discrepancies in data on fatal overdoses across counties, suppression of county-level data on hospitalizations and overdoses due to confidentiality concerns in small/rural areas, unavailable data on treatment information and opioid overdoses, difficulties with data from the criminal justice sectors, no uniform data collection and statistics on overdoses, no unique patient identifiers in EMS databases (which makes it difficult to track repeat clients when variations in name or date of birth are provided to EMS on different occasions) , and difficulty with getting prehospital providers to register kit distribution or recording opioid overdose reversals with naloxone.
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From page 103... ...
Interviews of FR-CARA grantees conducted by NORC suggest that grantees wanted SAMHSA to be more intentional in interactions with them while being more present, including consistent communication between grantees and program officers at SAMHSA. Almost half of grantees interviewed by NORC had either a strained or nonexistent relationship with their SAMHSA Government Program Officer due to a lack of communication and/or having a new program officer assigned up to three times during their grant.
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From page 104... ...
Additionally, efforts around the agency have been limited as many people have been home due to health conditions that put them at-risk to the pandemic. FR-CARA grantees reported that partnerships and grant progressions were heavily impacted by social distancing guidelines, lockdowns, individual safety, and resource constraints.
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From page 105... ...
Additionally, some grantees reported law enforcement agencies were reluctant to carry naloxone due to "liability risks"; this legal issue presented a barrier to partnering with such agencies. One grantee also noted that the "legal review process prevented our funded partners from incurring costs to implement linkage services, data collection and performance evaluation." A common barrier reported by grantees was data and linkage limitations with partners, which impacted program design, implementation, and evaluation.
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From page 106... ...
illustrate, while grantees described their focus on individuals, it is not usually clear how many individuals were affected (in terms of overdose reversal) or specific linkages in most cases to project activities (other than the first listed individual examples reporting a number of actual observed reversals of overdose, potentially preventing death in specific examples)
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From page 107... ...
, grantees commented on the broader impact their CARA grant program could have on individual attitudes and public perception on overdose and recovery by highlighting the need within their community. NORC noted that grantees identified stigma among individuals administering overdose prevention medications (e.g., first responders, key community members)
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From page 108... ...
NORC also identified data requests as a barrier for addressing stigma: NORC noted that grantees reported that those at risk of experiencing an overdose were less likely to receive overdose prevention medication kits if asked to complete documentation of any kind -- for example, asked for a name or demographics. More broadly NORC identified data gaps in having population impact information.
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From page 109... ...
Sometimes it was possible to determine whether the grantee agency or partners were responsible for or involved in the structural and environmental changes; most often when these were reported, it was not possible from the available summaries and comments to determine the source of the changes instituted. Structural and environmental goals and impacts were primarily focused around expanding community partnerships or community agency roles, promoting policy change and advocacy or system regulation changes, addressing disparities for high-risk populations, and having the necessary data and support for these goals, and sometimes for sustainability.
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From page 110... ...
Another example of alignment with policy to meet program goals included: "Emergency medical services providers can carry and administer naloxone under state protocol and were tested for competency in administering this drug under state scope of practice training." The committee notes that several types of EMS providers have been shown to be effective at administering naloxone (Gulec et al., 2018)
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From page 111... ...
One grantee noted: Law enforcement officers and firefighters without EMS certification must be licensed to carry and administer naloxone; Resource constraints and resistance among law enforcement officers to become licensed to carry and administer naloxone caused us to focus more on Fire and EMS agencies. Another noted: In the rural counties, the area's Law Enforcement and Fire/EMS authorities do not envision the Opiate Issue to be as bad and as the EMS departments currently already carry Naloxone from the hospital drug bag program (which contains Naloxone)
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From page 112... ...
. Just as this example illustrates the use of data to help overcome barriers or develop support for implementing programs more broadly, other grantees noted that data are needed to convince policy makers to support sustainability; and one grantee noted particularly the importance of data to inform EMS (first responder)
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