Increasing Referrals to Medications for Opioid Use Disorders from Drug Treatment Courts using Organizational Linkage Intervention

项目摘要/摘要 拟议的K23职业发展方案将为Ekaterina Pivovarova博士提供培训和飞行员 在应用实施科学进行独立研究以增加对 以经验为基础的物质使用障碍(SUD)正义治疗涉及个人。阿片类药物 服药过量是涉及司法的个人的主要死亡原因。然而，司法系统中的大多数人 系统未能获得阿片使用障碍的黄金标准治疗-阿片使用障碍的药物 (Mouds)。戒毒法庭(DTC)是一种转移注意力的项目，它利用法律制裁来换取 强制性和法院监督的sud治疗。全国有3100多个DTC项目 在社区里用肥皂水管理数以千计的罪犯。尽管他们专注于成瘾治疗， DTC在将Mouds作为标准做法纳入方面进展缓慢。在数字技术中心中使用MOUD的系统性障碍 已经得到了很好的记录，包括沟通不畅，缺乏合作和关系 社区中的Moud提供者。拟议的研究直接解决了沟通中的障碍和 DTC和社区Moud提供者之间的推荐做法，通过采用实施战略， 此前在社区矫正项目中被证明是有效的。阿片类药物的使用 在药物治疗法庭实施精神障碍是一项执行战略，其目的是 改善机构间关系，增加高危个人获得MODS的机会。使用 综合实施研究框架(CFIR)，将进行混合方法研究，以 实现这些具体目标：1)评估当前的MOD推荐做法、障碍、促进者和准备情况 变化2)制定Moudi-DTC实施战略和手册，3)实施Moudi-DTC 12个月 并对实施策略的有效性、接受度和可行性进行评估。调查结果将 提供关于Moudi-DTC在增加转诊以及可接受性和可行性方面的效果的初步数据 最终在全国范围内推广和评估这一战略。这些发现还将为飞行员提供 开发一项R01随机临床试验的数据，以比较Moudi-DTC和#年通常的转诊做法 DTC。更广泛地说，这项研究将导致开发关于DTC应如何进行的最佳实践指南 与穆德社区提供者合作，增加获得护理和转诊到穆德的机会。完成这项研究 将作为Pivovarova博士严格培训计划的一部分，以便在1) 实施科学，2)Moud，3)组织理论和系统层面的干预。在K23赛道上， Pivovarova博士将从该领域的领先研究人员那里获得个性化和团队指导 司法环境中的执行科学和南部非洲疾病治疗：彼得·弗里德曼博士(初级)，斯蒂芬妮 莱蒙、大卫·斯梅尔森和费伊·税务局。

PROJECT SUMMARY/ABSTRACT The proposed K23 Career Development program will provide Dr. Ekaterina Pivovarova with the training and pilot data necessary to conduct independent research in applying implementation science to increase access to empirically based substance use disorder (SUD) treatments for justice involved individuals. Opioid-related drug overdose is a leading cause of death for individuals with justice involvement. Yet, most individuals in the justice system fail to receive the gold standard treatment for opioid use disorder – medications for opioid use disorder (MOUDs). Drug treatment courts (DTC) are diversionary programs that leverage legal sanctions in exchange for mandatory and court-monitored engagement in SUD treatment. There are over 3,100 DTC programs nationwide that manage thousands of offenders in the community with SUDs. Despite their focus on addiction treatment, DTCs have been slow to incorporate MOUDs as standard practice. Systemic barriers to use of MOUD in DTCs have been well documented and include poor communication and lack of collaboration and relationships with MOUD providers in the community. The proposed study directly addresses barriers in communication and referral practices between DTC and community MOUD providers by adapting an implementation strategy, which has been previously shown as effective in community corrections programs. The Medication for Opioid Use Disorders Implementation – in Drug Treatment Courts (MOUDI-DTC) is an implementation strategy that aims to improve interagency relationships and increase access to MOUDs for high-risk individuals. Using the Consolidated Framework for Implementation Research (CFIR), a mixed-methods study will be conducted to achieve these specific aims: 1) evaluate current MOUD referral practices, barriers, facilitators, and readiness for change 2) develop MOUDI-DTC implementation strategy and manual, 3) implement MOUDI-DTC for 12 months in three DTCs and evaluate efficacy, acceptance and feasibility of the implementation strategy. The findings will provide preliminary data about efficacy of MOUDI-DTC on increasing referrals and acceptability and feasibility of MOUDI-DTCs to ultimate expand and evaluate the strategy nationwide. The findings will also provide pilot data for developing an R01 randomized clinical trial to compare MOUDI-DTC to referral practices as usual in DTCs. More broadly, this research will lead to development of best-practice guidelines about how DTCs should work with MOUD community providers to increase access to care and referrals to MOUDs. Completing this study will serve as one component of a rigorous training plan for Dr. Pivovarova to receive directed training in 1) implementation science, 2) MOUD, and 3) organizational theory and systems level intervention. During the K23, Dr. Pivovarova will receive individualized and team mentorship from leading researchers in the field of implementation science and SUD treatment in justice settings: Drs. Peter Friedmann (primary), Stephenie Lemon, David Smelson, and Faye Taxman.