Public and Behavioral Health

State Opioid Response Grant Program Evaluation

Implementation, Impact & Summative Evaluation

Overview

The Office of Behavioral Health, Department of Human Services received federal funding from the Substance Abuse and Mental Health Services Administration’s (SAMHSA) State Opioid Response (SOR) grant to connect individuals experiencing opioid use disorder with treatment and resources needed for recovery. The Evaluation Center supports the monitoring and evaluation for several program initiatives under the SOR grant.

Projects Summary

Community Reinforcement Approach

The Community Reinforcement Approach (CRA) is a client-centered, psychosocial treatment approach that is designed to support clients in setting prosocial goals and developing healthier behavior patterns. CRA counselors help clients make better choices, teach problem solving skills, and encourage self-guided decision making. The approach is non-confrontational, facilitating authentic conversation and providing support and focus on relationship building between the client and counselor. Clients establish their own treatment goals and are supported by counselors who help them get in touch with activities and topics of interest to them. Evaluators are currently working with the client to develop long term evaluation strategies of the CRA program.

Feasibility Assessment for Culturally Appropriate Treatment in Native American Communities

Substance use disorder (SUD) and treatment within Tribal communities and for Indigenous people encompasses cultural implications and is overlaid by complex federal, state, and Tribal government interplays. Disparities and inequities in access to healthcare stem from historical and structural processes that disproportionately affect Tribal communities. This project aims to spotlight the landscape of SUD treatment for AI/AN adults in Colorado, with particular focus on live-in supported (residential) treatment, and how it is funded. The funding assessment is contextualized by an expanded review of the limitations and challenges of assessing needs in Tribal communities, including the limitations and challenges of data collection and the access to and availability of culturally relevant live-in supported treatment options for Southern Ute, Ute Mountain Ute, and all AI/AN in Colorado.

Individual Placement and Support Services

Individual Placement and Support Services (IPS) is a model of supported employment, helping individuals find work of their choosing, including support for participants’ interests in education and technical training. It is an evidence-based practice historically provided in mental health settings. IPS leaders and the international IPS community have focused on expanding IPS beyond mental health settings to substance use treatment centers. The SOR grant provided the opportunity to focus on recovery services for individuals with OUD/SUD, given that employment and sense of purpose are important elements of recovery. The IPS program is hosted by Opioid Treatment Program (OTP) partners in six clinical sites located in Denver, Fort Collins, Grand Junction, Littleton, Longmont, and Pueblo.

Jail-Based and Medication Assisted Treatment

The Jail-based Medication Assisted Treatment program (JMAT) was an initiative in Colorado to provide medication assisted treatment (MAT) to individuals within county jails that have opioid use disorder. Evaluators reviewed policies related to providing MAT from participating counties and interviewed jail staff, jail-based clinicians, community clinicians and treatment professionals, and leaders of recovery initiatives to learn about best practices when implementing MAT programs within county jails and what resources are critical for successful implementation.

Mobile Health Units Delivering Medication-Assisted Treatment

The aim of the mobile health services program is to improve access to medication-assisted treatment in rural and underserved areas of Colorado. Six mobile health units, staffed with a nurse, a licensed addictions counselor, and a peer recovery coach are delivering care to persons seeking treatment for substance use disorders. Services offered include access to a healthcare provider who can prescribe medication for an opioid use disorder, Naloxone distribution, referrals to wraparound services, and syringe disposal.

Peer Recovery Coaches/Peer Navigators

Peer Recovery Coaches, also called Peer Navigators are individuals with lived experience of substance use that provide holistic support to individuals in the community who are experiencing substance use disorder. They work to help individuals get connected to treatment and recovery resources, as well as other supports an individual may need to gain greater stability in their life. The SOR grant funds numerous Peers across Colorado in both treatment and community organization settings. Evaluators conducted an initial process evaluation to learn how Peers are being integrated into recovery communities and what supports they need to succeed. Evaluators also conduct ongoing monitoring on the amount and type of services provided by Peers across the state.

Government Performance Results Act (GPRA)

SOR-funded providers are required to complete a GPRA intake for all clients receiving SOR-funded services. OBH has partnered with The Evaluation Center to collect the mandated GPRA data for clients receiving SOR-funded treatment. The Evaluation Center monitors intake GPRA data collected by treatment sites, as well as maintaining contact with GPRA clients throughout their recovery journey and administering follow-up and discharge surveys. We also provide tailored technical assistance and training related to SOR GPRA data collection and entry, the GPRA intake process, and instruction on how to navigate SAMHSA’s Performance Accountability and Reporting System (SPARS) portal.

Evaluation Approach

The IPS, Peers, CRA and MHU evaluations are based on the RE-AIM Framework (reach, effectiveness, adoption, implementation, and maintenance). A multi-methods approach is used across all the evaluations including:

  • Logic model development
  • In-depth interviews
  • Focus groups
  • Journey mapping
  • Quantitative analysis of administrative data
  • Surveys
  • Geographic mapping
  • Shared data interpretation

The Feasibility Assessment for Culturally Appropriate Treatment in Native American Communities was guided by the principles of the Indigenous Evaluation Framework, ensuring respect for Tribal data self-determination.

For GPRA, we developed HIPAA-compliant tracking systems for monitoring and data collection. We also created a tracking system so Peer Navigators can collect real-time de-identified data in the field using their cell phones.

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Timeline

October 2018 – September 2022

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