Consensus Study Report

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International Standard Book Number-13: 978-0-309-69753-8
International Standard Book Number-10: 0-309-69753-0
Digital Object Identifier: https://doi.org/10.17226/26831

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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2023. Review of four CARA programs and preparing for future evaluations. Washington, DC: The National Academies Press. https://doi.org/10.17226/26831.

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COMMITTEE ON THE REVIEW OF SPECIFIC PROGRAMS IN THE COMPREHENSIVE ADDICTION AND RECOVERY ACT

KENNETH B. WELLS (Chair), Director, Center for Health Services and Society, Semel Institute, University of California, Los Angeles

HORTENSIA AMARO (Vice Chair), Distinguished University Professor and Senior Scholar on Community Health, Florida International University

GINA BRYAN, Director and Clinical Professor, Post Graduate Psych-Mental Health Program, University of Wisconsin–Madison

KAREN CROPSEY, Conaster Turner Endowed Professor of Psychiatry, The University of Alabama at Birmingham

MARCELA HORVITZ-LENNON, Senior Physician Scientist, RAND Corporation

SANDEEP KAPOOR, Assistant Professor, Medicine, Emergency Medicine, and Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell

RAYMOND C. LOVE, Professor and Director, Mental Health Program, School of Pharmacy, University of Maryland

ROSALIE PACULA, Professor and Elizabeth Garrett Chair in Health Policy, Economics, and Law in the Sol Price School of Public Policy, University of Southern California

JOSÉ A. PAGÁN, Chair and Professor, Department of Public Health Policy and Management, New York University School of Global Public Health

SHARON REIF, Professor, Heller School for Social Policy and Management, Brandeis University

GERY RYAN, Professor, Health System Science, Kaiser Permanente Bernard J. Tyson School of Medicine

Study Staff

KATHLEEN STRATTON, Study Director

M. KELLY McHUGH, Associate Program Officer

CRYSTI PARK, Administrative Assistant

MISRAK DABI, Senior Financial Business Partner

ROSE MARIE MARTINEZ, Senior Board Director

CHRISTOPHER LAO-SCOTT, Senior Research Librarian

NAM Fellow

RUCHI FITZGERALD, Service Chief, Inpatient Addiction Medicine at PCC Community Wellness

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Reviewers

This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.

We thank the following individuals for their review of this report:

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report nor did they see the final draft before its re-

lease. The review of this report was overseen by JACK C. EBELER, member of NASEM Health and Medicine Division committee, and JOSIAH (JODY) D. RICH, Brown University. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.

Acknowledgments

The committee of this study thanks both the Substance Abuse and Mental Health Services Administration and the Comprehensive Addiction and Recovery Act grantees for their work and for providing information to the National Academies for this report series.

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Contents

ACRONYMS AND ABBREVIATIONS

SUMMARY

1 INTRODUCTION

Comprehensive Addiction and Recovery Act

The Four Programs

Report Series Statement of Task

Interpretation of the Statement of Task

Organization of the Report

2 METHODS AND APPROACH

Assessing Effectiveness: Approach

Assessing CARA Programs: Streams of Information

Future Evaluation Mandates: Approach

3 BCOR FINDINGS

Program Purpose

Information Sources and Limitations

Findings: Grantee Activities

Findings: Partners and Network

Findings: Structural and Environmental Change

Findings: Individual-Level Outcomes

Findings: Community-Level Outcomes

4 PPW-PLT FINDINGS

Program Purpose

Information Sources and Limitations

Findings: Grantee Activities

Findings: Partners and Network

Findings: Structural and Environmental Change

Findings: Individual-Level Outcomes

Findings: Community-Level Outcomes

5 OD TREATMENT ACCESS FINDINGS

Program Purpose

Information Sources and Limitations

Accomplishments: Grantee and Partner Activities

Accomplishments: Structural and Environmental Change

Barriers to Project Activities and Structural Change

Findings: Individual-Level Outcomes

Findings: Community-Level Outcomes

Summary

6 FR-CARA FINDINGS

Program Purpose

Information Sources and Limitations

Findings: Grantee and Partner Activities

Findings: Outcomes

Findings: Structural and Environmental Change

7 CONCLUSIONS ABOUT THE CARA PROGRAMS

Limits on Inferences About Program Effectiveness

Assessing Grantee Activities

Significant Obstacles

8 PREPARING FOR FUTURE EVALUATIONS

Introduction

Recommendations

Implications for the Future of the Four CARA Programs

9 CONCLUDING OBSERVATIONS

REFERENCES

APPENDIXES

A SUPPLEMENTARY PROGRAM INFORMATION

B CONTRACTED NORC REPORT

C EVALUATION TYPES AND DATA REQUIREMENTS

D COMMITTEE MEMBER BIOGRAPHICAL SKETCHES

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Acronyms and Abbreviations