Implementation evaluation of a Massachusetts pilot program designed to reduce overdose deaths among Black and Latino men returning from incarceration.

Introduction and context: In response to rising and disproportionate overdose deaths, a Massachusetts agency developed a program model (CARE) that incorporated evidence-based and evidence-informed practices to support recovery and overdose prevention for Black and Latino men returning to their communities from incarceration. Recruitment of Black and Latino men at risk of overdose was intended to begin in local jails prior to release. Key program components included culturally-responsive care, person-centered care, support for social determinants of health (SDoH), community building and social support, and facilitating access to evidence-based substance use disorder (SUD) treatment and harm reduction services. The evaluation used the RE-AIM framework to examine the program's reach, adoption, and implementation among five community-based providers with varied sizes, populations of focus, prior experience with similar services, and institutional capacities. Evaluation methods: The evaluation used a participatory process to develop a theory of change for CARE and corresponding mixed-methods data collection procedures. Qualitative data were collected from semi-structured interviews and focus groups with 35 staff members, and interviews with 41 clients. Quantitative data sources included administrative program data on client characteristics, contacts, and service planning. Results: The evaluation found considerable inter-provider variation in recruitment of the focus population, with underrepresentation of Black men, and people with substance use histories that indicate highest overdose risk. All providers experienced challenges with recruitment and retention of staff. A minority of funded organizations established dedicated program space in alignment with the program design. Most providers experienced challenges with client recruitment in local jails. Providers successfully implemented culturally-responsive care and supporting SDoH needs. Implementation success was more mixed around community-building, the provision of person-centered care, and facilitating access to evidence-based substance use disorder treatment and harm reduction services. Discussion: The evaluation demonstrates that while the CARE program model is generally feasible, successful implementation of the core program elements was correlated with organizational size, longevity, experience with grant-funded program implementation and SUD service delivery, and physical infrastructure. Evaluation findings highlight lessons that can be used by funders and programs to effectively engage and serve populations at high risk of overdose, as well as future directions for further evaluation.