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

项目总结/摘要 拟议的K23职业发展计划将为叶卡捷琳娜·阿尔瓦罗娃博士提供培训和试点 开展独立研究以应用执行科学， 基于经验的物质使用障碍（SUD）治疗的正义涉及个人。阿片类药物 吸毒过量是司法人员死亡的主要原因。然而，大多数人在司法 系统未能接受阿片类药物使用障碍的金标准治疗-阿片类药物使用障碍的药物 （MOUDs）。毒品治疗法庭（DTC）是一种转移注意力的计划，利用法律的制裁来换取 强制性和法院监督的参与SUD治疗。全国有3,100多个DTC项目 管理着社区里数以千计的SUD罪犯。尽管他们专注于成瘾治疗， DTC在将谅解备忘录纳入标准做法方面进展缓慢。在DTC中使用MOUD的系统性障碍 有据可查，包括沟通不畅，缺乏合作和关系， 社区中的MOUD供应商。拟议的研究直接解决沟通障碍， DTC和社区MOUD提供商之间的推荐实践，通过调整实施策略， 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障碍是一项实施战略，旨在 改善机构间关系，增加高风险个人获得MOUD的机会。使用 实施研究综合框架（CFIR），将进行混合方法研究， 实现这些具体目标：1）评估当前MOUD推荐实践，障碍，促进者和准备 变更2）制定MOUDI-DTC实施战略和手册，3）实施MOUDI-DTC 12个月 在三个接受培训国家开展培训，评估实施战略的有效性、可接受性和可行性。其成果将 提供关于MOUDI-DTC在增加转诊、可接受性和可行性方面的有效性的初步数据 最终在全国范围内扩大和评估该战略。调查结果还将提供试点 用于开展R 01随机临床试验的数据，以比较MOUDI-DTC与常规转诊实践， DTC。更广泛地说，这项研究将导致制定最佳实践指南，指导DTC如何 与MOUD社区提供者合作，增加获得护理和转诊到MOUD的机会。完成本研究 将作为一个严格的培训计划的一个组成部分，为Dr. Zavarova接受定向培训1） 实施科学，2）MOUD和3）组织理论和系统级干预。在K23期间， 博士Eschvarova将获得来自该领域领先研究人员的个性化和团队指导， 司法环境中的实施科学和SUD治疗：Peter Friedmann博士（初级）、Stephenie 莱蒙，大卫·斯梅尔森，和菲伊·塔克斯曼。

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.