A cluster randomized trial of an organizational linkage intervention for offenders with substance use disorders: study protocol.
A cluster randomized trial of an organizational linkage intervention for offenders with substance use disorders: study protocol.
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DOI：
10.1186/2194-7899-1-6
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发表时间：
2013-12-19
期刊：
影响因子：
3.5
通讯作者：
Fenster, Juliane
中科院分区：
文献类型：
--
作者：
Friedmann, Peter D;Ducharme, Lori J;Fenster, Juliane
背景：物质使用障碍在社区矫正人群中非常普遍，然而这些环境往往缺乏识别和将罪犯转介到社区治疗服务的能力。特别是，社区矫正工作人员往往反对在成瘾治疗中使用药物，因为他们缺乏知识、资源和组织结构，无法促进客户与循证服务的联系。方法/设计：每个nida资助的研究中心招募2个刑事司法机构参与研究。资格规则要求研究地点专注于社区矫正（即缓刑或假释），与治疗提供者很少或没有正式关系，以介绍客户进行药物辅助治疗，并且没有州或地方政策禁止这种关系。同一母机构监管下的地点只有在地理上不同的集水区才有资格，并且可以被分配到不同的研究小组，没有任何程度的交叉污染。这18个小组由社区矫正官员和他们的罪犯案件组成，每个小组都与至少一个以社区为基础的药物滥用治疗项目合作。研究中心阻止了随机化，其中一组随机分配到仅培训条件（比较），另一组随机分配到培训后的战略组织联动过程（干预）。一线工作人员接受了有科学依据、系统提供的培训课程，以解决现有知识、观念和信息方面的差距，包括药物辅助治疗（MAT）和MAT服务在当地的可得性。随后要求主要决策者在战略规划进程中进行合作，以加强刑事司法机构与当地MAT提供者之间的正式和非正式联系。据推测，两个实施干预组成部分一起比单独的工作人员培训更有可能改善社区监督下阿片类药物和酒精依赖成年人转介到适当的成瘾药物治疗的过程。结果在客户（推荐）、一线员工（态度）和组织（联系）层面进行测量。讨论：通过刑事司法机构和治疗提供者之间更密切的合作，改善与有效药物滥用治疗的联系应能产生重大的临床、公共卫生和公共安全效益。
BACKGROUND: Substance use disorders are highly prevalent in community correctional populations, yet these settings frequently are ill-equipped to identify and refer offenders to community-based treatment services. In particular, community corrections staff are often opposed to the use of medication in addiction treatment because of inadequate knowledge, resources, and organizational structures to facilitate client linkages to evidence-based services.METHODS/DESIGN: Each of the NIDA-funded Research Centers recruited 2 criminal justice agencies to participate in the study. Eligibility rules required study sites that were focused on community corrections (i.e., probation or parole), had few or no formal relationships with treatment providers for referring clients to medication-assisted treatment, and had no state or local policies prohibiting such relationships. Sites under the oversight of the same parent agency were eligible only if they were in geographically distinct catchment areas, and could be assigned to different study arms without cross-contamination at any level. The 18 clusters consisted of community corrections officers and their offender caseloads nested within agencies, each of which was partnered with at least one community-based substance abuse treatment program. Randomization was blocked by Research Center, within which one cluster was randomly assigned to a training-only condition (comparison) and the other to training followed by a strategic organizational linkage process (intervention). Line staff received a scientifically-grounded, systematically-delivered training session that addresses gaps in existing knowledge, perceptions, and information about medication-assisted treatment (MAT) and local availability of MAT services. Key decision-makers subsequently were asked to collaborate in a strategic planning process to enhance formal and informal linkages between criminal justice agencies and local MAT providers. It was hypothesized that the two implementation intervention components together would be more likely than staff training alone to improve the process of referring opioid- and alcohol-dependent adults under community supervision to appropriate addiction pharmacotherapy. Outcomes were measured at the client (referrals), line staff (attitudes), and organizational (linkage) levels.DISCUSSION: Through closer collaboration among criminal justice agencies and treatment providers, improved linkages to effective substance abuse treatment should yield significant clinical, public health and public safety benefits.