Three communities that had been particularly hard-hit by the Great Recession submitted applications for and were awarded the funds to implement the CRRI program. One was Union City, New Jersey, a compact (1.27 square miles) urban community located just across the Hudson River from Manhattan. Its population of 66,500 is largely Hispanic (85 percent). Many people in Union City work in the manufacturing and service industries, both of which took a major hit in the recent recession. Union City experienced a rise in unemployment from 9 percent in 2007 to 14 percent in 2009. In 2010 when the initiative began, the unemployment rate had recovered from its 2009 peak, but was still above pre-recession levels at 10.4 percent. In its application, the Mayor's Office partnered with North Hudson Community Action Corporation (NHCAC) and proposed to implement three evidence-based prevention programs. One was the JOBS Project, a program out of the University of Michigan that focused on providing job-seeking skills and mitigating feelings of depression or anxiety among individuals who were out of work. In addition to this focus on displaced workers, Union City proposed to combat the challenges of youth substance use disorders by implementing the Strengthening Families Program and the Strengthening Families Program for Parents and Youth 10-14. Because of significant challenges with substance use in the city's schools, eligible youth and families would be recruited through the school district. All three programs were to be translated to meet the needs of the city's Spanish-speaking population.
A second grantee was Fall River, Massachusetts. This community, located near the border with Rhode Island, was once one of the leading textile manufacturing cities in the United States. Throughout the 19th and early 20th centuries, the city remained vibrant as the types of industries changed with the transformations in the American economy. Shortly after World War II, however, Fall River's fortunes began to decline. Indeed, over the past quarter century it suffered from the continued loss of positions in both the manufacturing and service sectors, a loss that was exacerbated by the Great Recession. In 2007, the city's unemployment rate was 8.3 percent; by 2010, the unemployment rate was in double digits at 15.8 percent5 and an estimated 20 percent of residents were living in poverty (Census Bureau, 2010). With the depressed economy came a host of behavioral health challenges for city residents. Compared with the state as a whole, Fall River adults reported higher rates of depression and rates of injection drug use (primarily heroin).
In its application, the Mayor's Office partnered with a long-standing substance use disorder service provider in the city, SSTAR, to develop and implement the four-level intervention spelled out in the RFA. Ultimately, SSTAR proposed to use a 6-month case management approach to meet the behavioral health needs of individuals who screened positive for depression, anxiety, or problematic substance use. Other evidence-based interventions including Parenting Wisely and The Incredible Years, two family strengthening programs that have a strong research base; the ARISE intervention, a substance use intervention approach that was successfully tested by the National Institute on Drug Abuse; and a Job Club, an employment training and support group for displaced workers.
The third funded application was from Lorain, Ohio, a town of about 70,000 residents located on the shores of Lake Erie, approximately 30 miles west of Cleveland. The area's experience with economic decline had spanned decades and was largely related to the falling fortunes of the auto industry and, more generally, manufacturing. The negative impacts of the Great Recession were particularly egregious, exacerbating the social and economic distress of Lorain's citizens. In December 2007, the unemployment rate among city residents was 7.3 percent; by February 2009, that figure had soared to 12.5 percent.6 Selected city data compiled in 20087 reflected a poverty rate among community residents that was over 25 percent; a local crime rate that surpassed the national average; and a local median income that was $13,000 below the median income for Ohio residents. The recession also was felt at the state level, resulting in budget cuts to an array of service organizations, including those that deliver health care, mental health care, or substance use disorder treatment services.
It was within this context that the Mayor's Office, working in partnership with the Alcohol and Drug Addiction Services (ADAS) Board of Lorain County, submitted its application for the CRRI initiative. Their proposed program, Partners Realistically Integrating Durable Empowerment (PRIDE), included several evidence-based strategies, including the Strengthening Families Program, a Spanish-language version of the Strengthening Families Program for Youth 10-14, and the same JOBS Project that was identified by Union City as an evidence-based intervention for displaced workers. Lorain was unlike the other two sites in that the application was submitted by a board, not a service provider. Thus the successful implementation of PRIDE required a strong Policy Steering Committee and committed partnerships among service providers in the city.