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
Type of Evidence
Response Approach
Early Intervention
Family Support
Medications for Opioid Use Disorder
Peer-reviewed Article

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."