The CRRI was an important and ambitious undertaking. It aimed to help the three grantee communities recover from the behavioral health effects of the Great Recession, as well as arm these cities and their citizens with the tools to better handle any subsequent economic downtowns. Because of the shortened timeframe of the initiative as well as significant challenges with the community data for each grantee, our evaluation is inconclusive regarding the impact of these grants on the broader communities. Findings do indicate, however, that many of the individuals who received services through the initiatives reported improved outcomes in both employment and self-reported behavioral health symptoms. In addition, the grants had a positive impact on the service delivery infrastructure in each of these communities. For example, the many requirements of the CRRI grant for partnerships, screening, and collaborations with new entities led individuals and organizations to examine their entire community in much greater detail. In gaining an understanding about the link between economic distress and behavioral health challenges, new linkages have been formed between behavioral health providers and employment services in each community. Likely these cross-referrals will continue going forward.
Another important aspect of this effort was the project's emphasis on the need to continually outreach and share mental health and substance program resources with the wider community. Through grantees' outreach and screening efforts, there is increased awareness among many residents about how depression, substance use, and unemployment during times of poor economic conditions are connected. In addition, staff in all three sites believed that their efforts had reduced the stigma around help-seeking for mental health services and reached people who would not normally access behavioral health supports. Because outreach and screening are not reimbursable services for providers, however, communities will have to identify financial resources that will allow them to engage in these activities. Offering grant opportunities similar to CRRI to other communities would allow them to experience the same learning about how screening, coaching on help-seeking, reducing stigma and coordinating service systems to be more collaborative can lead to improved service access and client outcomes.
The CRRI grants also provided resources that allowed financially strapped organizations to hire needed staff. In Lorain, for example, several public health nurses were able to return to duty after a layoff and provided critical outreach services to city residents. In Union City, staff adapted all outreach and treatment resources for Spanish-language community members and hired bilingual staff to meet the specific needs and values of this community. Service providers are generally aware of service gaps in their communities, but do not always have the resources to meet their residents' needs. The CRRI projects allowed three communities to take positive steps towards addressing their varied gaps in service outreach and delivery.
Grant-funded projects must always strike a balance between requiring all grantees to engage in the same activities and allowing grantees to modify their approaches to meet the unique needs in their communities. While the variations are problematic from an evaluation standpoint, the flexibility of the CRRI grants resulted in some important innovations. For example, in Union City, the grantee recognized the centrality of youth within the ethos of that city's residents. Rather than focus on serving adults directly, they developed a high school substance use program that also acted as a tool to recruit more community families into mental health and other services. Lorain's project director believed that the African American residents of that community had not only been adversely affected by the Great Recession, but also had long-standing unemployment challenges that had not been adequately addressed by the service delivery system. She thus paid particular attention to this segment of the city's population, despite the fact that this population's employment-related issues were more "chronic" than emergent. Finally, Fall River adopted a case management model to provide "brief" interventions to enrolled clients. Although case management is a much more intensive service delivery model than was adopted by the other two grantees, these 6-month relationships were linked to positive client outcomes and contributed to the collection of a fairly complete set of data for analysis.
The CRRI grants allowed innovative treatment approaches, new community partnerships, and the awareness of a critical connection between economic distress and behavioral health issues among service providers. It is hoped that these accomplishments will contribute to the resilience of these three communities should they face widespread economic challenges in the future.