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Project CARA: Care that Advocates Respect/Resilience/Recovery for All

Comprehensive substance use treatment for pregnant and new mothers in a largely rural areas of western North Carolina

Project CARA: Care that Advocates Respect/Resilience/Recovery for All was begun in 2014 by the Mountain Area Health Education Center (MAHEC) to provide comprehensive substance use disorder treatment to pregnant women in a largely rural area of western North Carolina. The goals of the program are to remove obstacles to care delivery and improve health and social outcomes for women and their babies. 

Serving 20 counties in western North Carolina and serving more than 800 pregnant women with substance use disorder, Project CARA uses a hub and spoke model to integrate medical and behavioral healthcare and expand access. The hub is at MAHEC's high-risk obstetrics clinic and the spokes are partnerships with a wide range of organizations, including social services, treatment and recovery services, and community-based support. Some of the services that Project CARA and its partners provide include:

  • Routine OB/GYN appointments
  • Trauma-informed care
  • Medications for opioid use disorder 
  • Addressing social determinants of health, such as housing, transportation, and food security
  • Care coordination and warm handoffs
  • Peer support services

Project CARA has been designated and funded by Pew Trusts as a community-research collaborative with the University of North Carolina Health Sciences and is currently undergoing an evaluation. More information on the program can be found in the news article here and here, and the peer-reviewed paper here. Contact information and more program detail can be found in the presentation here,

Women who participated in Project CARA in 2017 were 36.5% less likely to test positive at delivery for illicit drugs than women tested at delivery prior to the program's inception. 

Continuum of Care
Treatment
Recovery
Type of Evidence
Peer-reviewed
Response Approach
Early Intervention
Family Support
Medications for Opioid Use Disorder
Peer-reviewed Article
A Cohort Comparison of Differences Between Regional and Buncombe County Patients of a Comprehensive Perinatal Substance Use Disorders Program in Western North Carolina
Related Resources
A Collaborative Approach to the Treatment of Pregnant Women with Opioid Use Disorders
Caring for Pregnant Opioid Abusers in Vermont: A Potential Model for Non-Urban Areas
State Options for Promoting Recovery among Pregnant and Parenting Women with Opioid or Substance Use Disorder
State Strategies to Address Opioid Use Disorder Among Pregnant and Postpartum Women and Infants Prenatally Exposed to Substances, Including Infants with Neonatal Abstinence Syndrome
Pregnancy and Substance Use: A Harm Reduction Toolkit
Treatment of Opioid Use Disorder in Pregnant Women via Telemedicine: A Nonrandomized Controlled Trial
Opioid Use, Misuse, and Overdose in Women
After Incarceration: A Guide To Helping Women Reenter the Community
The Ripple Effect: The Impact of the Opioid Epidemic on Children and Families
State Strategies to Meet the Needs of Young Children and Families Affected by the Opioid Crisis
The Impact of the Opioid Epidemic on Children and Adolescents

Evidence of Program Effectiveness

The program self-reports these changes from 2014 to 2017 among its participants with perinatal substance use disorder: 

  • Negative urine drug screens have increased from 33% to 57%
  • Attended expected number of visits has increased from 59% to 73%
  • Pharmacotherapy use has increased from 32% to 52%
  • Linkages to substance use treatment and social workers has increased substantially

A peer-reviewed paper found that prenatal outcomes for mothers who resided in the county where Project CARA is located were similar to outcomes for mothers who lived outside of the local county and were served by the program, although postpartum visits were higher for local women. 

The program reports that "research on the program has demonstrated that women who participated in CARA in 2017 were 36.5 percent less likely to test positive at delivery for illicit drugs than women tested at delivery prior to Project CARA’s inception in 2014."