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Preventing Opioid Use Among Justice-Involved Youth as They Transition to Adulthood: Leveraging Safe Adults (LeSA)

防止参与司法的青少年在向成年过渡时使用阿片类药物：利用安全成年人 (LeSA)

基本信息

批准号：
10209094
负责人：
DANICA K KNIGHT
金额：
$ 446.03万
依托单位：
TEXAS CHRISTIAN UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-30 至 2024-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10209094
关键词：
Address Administrator Adolescence Adolescent Adult Aging Alcohol or Other Drugs use Behavior Cessation of life Child Communities Complex Control Groups Criminal Justice Educational Intervention Effectiveness Effectiveness of Interventions Elements Enrollment Ensure Evidence based intervention Extended Family Family Family member Feedback Fentanyl Focus Groups Healthcare Heroin Hospitalization Hybrids Informal Social Control Intervention Investments Justice Manuals Mediating Mental disorders National Institute of Drug Abuse Nomenclature Opioid Outcome Overdose Parents Penetration Phase Populations at Risk Preventive Intervention Process Protocols documentation Public Health Randomized Readiness Rehabilitation Centers Risk Risk Factors Role Safety Secure Structure Subgroup Substance Use Disorder Surveys System Techniques Testing Training Trauma Trust Vehicle crash Vulnerable Populations Work Youth base cognitive reappraisal comparative contextual factors control trial cost cost effectiveness design effectiveness implementation study effectiveness testing emotion regulation empowered experience family support improved innovation juvenile justice system opioid misuse opioid overdose opioid use opioid use disorder prescription opioid misuse prevent recidivism recruit response social social relationships tool trial comparing

项目摘要

Project Summary/Abstract Across the US, substance use (SU) is a significant public health concern. Rates of opioid use disorders have increased exponentially, with 60% of overdoses attributed to heroin and illicit synthetics. Although opioid use among youth is low compared to adults, experimentation and regular use increases later in adolescence as youth transition to adulthood. Juvenile justice (JJ)-involved youth represent a particularly vulnerable population, as they often experience mental health disorders, dysfunctional family/social relationships, and complex trauma, placing them at greater risk for SU and substance use disorders (SUDs). To ensure that these youth do not become another opioid statistic, innovative and effective prevention interventions are needed. We propose to adapt and test an intervention for preventing initiation and/or escalation of opioid misuse among older JJ-involved adolescents. The target enrollment group will be youth aging out of JJ (16-18 years) who are transitioning to their communities after a period of detainment in a secure treatment or correctional facility. Trust-based Relational Intervention® (TBRI®; a relational, attachment-based intervention that promotes emotional regulation through interaction with responsive adults) will be adapted as a prevention intervention targeting youth at risk for SU (especially non-medical use of opioids). Safe adults (e.g., parent/guardian) will be trained in behavior management techniques for empowering youth to appropriately express their needs, connecting them with others in pro-social ways, and correcting or reshaping undesirable behavior. The proposed Effectiveness/Implementation study will be conducted in 3 phases. Phase 1 will adapt elements of TBRI for JJ youth, develop intervention manuals and study protocols, examine the acceptability of the adapted intervention, and test the feasibility of the proposed study protocol (e.g., agency and youth recruitment). Feedback from 15 youth/safe adult dyads will be solicited as part of this phase. Phase 2 will examine both the effectiveness of TBRI for preventing opioid misuse and the comparative utility of three support formats: (1) TBRI Training only, (2) TBRI Training + Structured Coaching, or (3) TBRI Training + Responsive Coaching (triggered by the youth’s need/risk). A total of 360 youth/safe adult dyads will be recruited from 6 participating JJ facilities over a 3-year period, and followed for 18 months post-release (20 youth-adult dyads/year per facility). This design enables a comparison of TBRI versus SRP (using a stepped-wedge design where each facility serves as its own control) plus a randomized control trial comparing 3 TBRI support formats. Phase 3 will examine barriers and facilitators of TBRI sustainment. Sixty JJ staff (10 from each agency) will provide input annually via focus groups and surveys. TCU will work with administrators and staff at each JJ facility to implement a sustainment plan, which will include developing in-house TBRI expertise (i.e., staff training and implementation assistance). Successful completion of study aims will provide a test of the adapted intervention and will facilitate sustainment by providing training and implementation support to participating facilities.

项目摘要/摘要在整个美国，物质使用(SU)是一个重大的公共卫生问题。阿片类药物使用障碍的比率呈指数级增长，60%的过量可归因于海洛因和非法合成药物。尽管阿片类药物的使用与成年人相比，年轻人的比例较低，青春期后期试验和定期使用的比例增加，因为青年向成年期过渡。涉及少年司法(JJ)的青年是特别脆弱的群体，因为他们经常经历精神健康障碍，失调的家庭/社会关系，以及复杂的创伤，使他们面临更大的SU和物质使用障碍(SUDS)的风险。以确保这些年轻人不要成为另一个阿片类统计数字，需要创新和有效的预防干预措施。我们提议调整和测试一项干预措施，以防止阿片类药物滥用在年龄较大的JJ相关青少年。目标登记群体将是JJ以外的青年(16-18岁)，他们是在安全治疗或惩教设施中被拘留一段时间后过渡到他们的社区。基于信任的关系干预®(TBRI®；一种基于关系、基于依恋的干预通过与反应灵敏的成年人互动进行情绪调节)将被调整为预防干预措施针对SU的高危青年(特别是非医疗使用阿片类药物)。安全的成年人(例如，父母/监护人)将接受行为管理技术培训，以增强青年适当表达其需要的能力；以亲社会的方式将他们与其他人联系起来，纠正或重塑不良行为。这个拟议的成效/实施研究将分三个阶段进行。第1阶段将调整以下元素为JJ青少年制定干预手册和研究方案，检查适应的进行干预，并测试拟议研究方案的可行性(例如，机构和青年招募)。作为这一阶段的一部分，将征求15名青年/安全成人双亲的反馈。第二阶段将研究 TBRI预防阿片类药物滥用的有效性和三种支持形式的比较效用：(1) 仅限TBRI培训，(2)TBRI培训+结构化培训，或(3)TBRI培训+响应性培训 (由年轻人的需要/风险引发)。将从6名参与者中招募360名青年/安全成人二人组 JJ设施超过3年，并在发布后跟踪18个月(每年20个青年-成人二人组设施)。此设计可以比较TBRI和SRP(使用阶梯式楔形设计，其中每个设施作为自己的对照)加上对3种TBRI支持形式进行比较的随机对照试验。第三阶段将审查TBRI维持的障碍和促进者。60名JJ工作人员(每个机构10名)将提供每年通过重点小组和调查进行投入。TCU将与每个JJ设施的管理员和工作人员合作，以执行一项维持计划，其中将包括发展内部技研专业知识(即，工作人员培训和实施援助)。研究目标的成功完成将提供对适应性干预的测试并将通过向参与设施提供培训和执行支助来促进维持。