Referral to and engagement in substance use disorder treatment within opioid intervention courts in New York: a qualitative study of implementation barriers and facilitators.
Referral to and engagement in substance use disorder treatment within opioid intervention courts in New York: a qualitative study of implementation barriers and facilitators.
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DOI：
10.1186/s13011-024-00593-y
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发表时间：
2024-01-29
影响因子：
3.3
通讯作者：
Tross, Susan
中科院分区：
文献类型：
--
作者：
O'Grady, Megan A.;Elkington, Katherine S.;Robson, Gail;Achebe, Ikenna Y.;Williams, Arthur Robin;Cohall, Alwyn T.;Cohall, Renee;Christofferson, Monica;Garcia, Alejandra;Ramsey, Kelly S.;Lincourt, Pat;Tross, Susan
关键词：
阿片类药物使用障碍（OUD）患者经常与法院系统接触，并且致命阿片类药物过量的发生率明显较高。阿片类药物干预法院（OIC）的建立是为了解决法院被告中阿片类药物过量率不断上升的问题，方法是让法院工作人员参与确定治疗需求和转诊阿片类药物相关服务，并在法院和OUD治疗系统之间建立合作。本研究的目的是了解在转介和吸引OIC客户参与OUD治疗方面的实施障碍和促进因素。对美国纽约10个县的OIC利益相关者（n = 46）进行了半结构化访谈，包括法院协调员、法院案件管理人员、物质使用障碍治疗诊所顾问、管理人员和同行。在探索、准备、实施、维持（EPIS）框架的指导下，采用归纳和演绎编码，对访谈进行了记录和转录，并进行了专题分析。使用EPIS内部（即法院）和外部（即OUD治疗提供者）的实施背景以及影响OIC转介和参与OUD治疗的桥接因素，将结果概念化。促进OIC实施的内部因素包括OIC理念（例如，非惩罚性，以获取为导向），法院组织结构（例如，强大的法院工作人员联系），以及OIC法院工作人员和客户特征（例如，积极的药物治疗OUD [mod]态度）。后两者也成为障碍（例如，缺乏正式的程序；对mod的污名）。两个外部背景实体既作为障碍又作为促进者影响了伊斯兰会议组织的实施：物质使用障碍治疗方案（例如，对伊斯兰会议组织和mod的态度；业务特征）和社区环境（例如，对阿片类药物流行的态度）。新冠肺炎疫情和保释改革是影响OIC实施的宏观外部背景因素。促进衔接因素包括衔接法院和治疗系统的人员配置做法（例如，同侪）；障碍包括系统之间的沟通和文化差异（例如，对伊斯兰会议组织客户成功的不同期望）。这项研究确定了oic在美国推广这种模式时可能考虑的主要障碍和促进因素。在伊斯兰会议组织的背景下，转介和参与OUD治疗需要不断努力，在治疗和法院系统之间建立桥梁，并减少对OUD的污名。
People with opioid use disorder (OUD) are frequently in contact with the court system and have markedly higher rates of fatal opioid overdose. Opioid intervention courts (OIC) were developed to address increasing rates of opioid overdose among court defendants by engaging court staff in identification of treatment need and referral for opioid-related services and building collaborations between the court and OUD treatment systems. The study goal was to understand implementation barriers and facilitators in referring and engaging OIC clients in OUD treatment. Semi-structured interviews were conducted with OIC stakeholders (n = 46) in 10 New York counties in the United States, including court coordinators, court case managers, and substance use disorder treatment clinic counselors, administrators, and peers. Interviews were recorded and transcribed and thematic analysis was conducted, guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, employing both inductive and deductive coding. Results were conceptualized using EPIS inner (i.e., courts) and outer (i.e., OUD treatment providers) implementation contexts and bridging factors that impacted referral and engagement to OUD treatment from the OIC. Inner factors that facilitated OIC implementation included OIC philosophy (e.g., non-punitive, access-oriented), court organizational structure (e.g., strong court staff connectedness), and OIC court staff and client characteristics (e.g., positive medications for OUD [MOUD] attitudes). The latter two also served as barriers (e.g., lack of formalized procedures; stigma toward MOUD). Two outer context entities impacted OIC implementation as both barriers and facilitators: substance use disorder treatment programs (e.g., attitudes toward the OIC and MOUD; operational characteristics) and community environments (e.g., attitudes toward the opioid epidemic). The COVID-19 pandemic and bail reform were macro-outer context factors that negatively impacted OIC implementation. Facilitating bridging factors included staffing practices that bridged court and treatment systems (e.g., peers); barriers included communication and cultural differences between systems (e.g., differing expectations about OIC client success). This study identified key barriers and facilitators that OICs may consider as this model expands in the United States. Referral to and engagement in OUD treatment within the OIC context requires ongoing efforts to bridge the treatment and court systems, and reduce stigma around MOUD.
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作者：
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DOI：
10.31478/202004b
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期刊：
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