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The report describes the National Health Emergency (NHE) Demonstration Grants to Address the Opioid Crisis: Implementation Evaluation findings and considers lessons learned and practices that appear potentially promising for future efforts to provide workforce services and system investments to support people directly and indirectly affected by the opioid crisis.

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Research Questions

• How were the grants implemented, and what factors—including grant context, management, and partnerships—appear to have influenced the implementation?
• What were the innovative strategies that grantees used to (1) provide employment services for people affected by opioid use disorder, (2) develop the health care workforce that serves people with opioid use disorder, and (3) prevent the negative effects of opioid use disorder in the workplace?
• What challenges did grantees encounter in implementation, and how were those addressed?
• What are the lessons learned from the NHE demonstration grants?

Key Takeaways

• Partnerships with the behavioral health system were reported as critical for grant implementation. Many of the relationships were new, and partners struggled at times to define the purpose of the partnerships. In some cases, behavioral health partners were viewed as sources for mutual referrals or “hosts” for workforce staff. In other cases, partners collaborated to co-create new programs such as a specialized work readiness training for individuals in recovery.
• Aligning the expectations of workforce development and behavioral health partners was challenging due to differences in culture and operations. In particular, the systems had different conceptions of “work readiness.” Behavioral health partners expected that anyone who wanted to work would be eligible for American Job Center (AJC) services, but AJCs turned down some potential clients with opioid use disorder whom they deemed not ready to take advantage of their services.
• Efforts to train AJC staff on how to interact with people in recovery appear potentially promising. Two of the grantees offered training for AJC staff on topics such as substance use disorders, what it means to be in recovery, and how to interact with people with opioid use disorder in a sensitive manner (such as by using person-first language) to help break down stigma around working with people in recovery and improve the experience of people in recovery who seek services at AJCs. Having trainers with lived experience seemed particularly impactful to interview respondents.
• Flexible grant eligibility requirements allowed states to take different approaches to participant recruitment, and the approaches were associated with differences in participant characteristics. Four grantees relied heavily on recruiting participants through behavioral health partner organizations and on-site outreach at treatment facilities and recovery organizations; the other two grantees primarily screened people already seeking AJC services. States with a targeted approach to recruiting participants impacted by the opioid crisis through behavioral health partnerships enrolled more participants with barriers to employment, including prior justice involvement, being homeless at enrollment, having a disability, and not being employed at the time of program entry.
• Frontline staff and administrators identified the need for intensive case management. People in recovery recruited through partnerships with behavioral health providers had complex needs and required more support than clients typically served at AJCs.
• Grantees reported substantial labor market demand and participants interested in peer recovery occupations, but labor market information about these careers is relatively limited. The Bureau of Labor Statistics does not track peer recovery specialists as a distinct occupation. To better understand the potential earnings of people entering these positions, more labor market information is needed, along with information on possible career paths and opportunities for advancement."
• The workforce system may be able to support a community’s recovery infrastructure by helping employers provide recovery-friendly workplaces. Providing technical assistance to employers through incumbent worker training, recovery-friendly workplace initiatives, and learning communities such as Project Extension for Community Healthcare Outcomes (ECHO) can magnify the workforce system’s impact on the outcomes of individuals in recovery.

Research Gaps

• Areas for further study: Evidence is needed regarding when people with opioid use disorder are ready to return to work. Employers would benefit from additional evidence regarding how to ensure safe and supportive conditions for people in medication-assisted treatment for opioid use disorder. Additional evidence is needed regarding outcomes for employment-related interventions for people with opioid use disorder, particularly regarding longer-term employment outcomes. (page 23)

Citation

Staatz, C., Berk, J., Blyler, C., Bodenlos, K., Mack, M., Gutierrez, I. (2021). Mathematica. National Health Emergency Grants to Address the Opioid Crisis: Implementation Study Final Report. Chief Evaluation Office, U.S. Department of Labor.

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The Department of Labor’s (DOL) Chief Evaluation Office (CEO) sponsors independent evaluations and research, primarily conducted by external, third-party contractors in accordance with the Department of Labor Evaluation Policy and CEO’s research development process.