Using Implementation Interventions and Peer Recovery Support to Improve Opioid Treatment Outcomes in Community Supervision

摘要 以前被监禁过的人死于 服药过量；特别是在出院后的头两周。超过450万人是美国人 在社区环境中受到监督，近一半的人患有药物使用障碍，但很少有人收到 服务。迫切需要将阿片类药物使用障碍(MOUD)与个人药物联系起来 关于社区监督。向个人提供治疗阿片使用障碍(Moud)的药物 缓刑或假释可降低旧病复发和再犯率，并增加实质上的保留率。 虐待治疗。2016年，RIDOC推出了首个惩教系统范围的Moud计划 国家启动一项综合计划，提供FDA批准的所有三种药物(在所有监狱或 监狱设置)提供给所有符合条件的个人。作为RIDOC计划的结果，我们扩展了Moud 与社区治疗的联系与全州范围内显著下降有关 释放后服药过量死亡。这项工作是我们建设当前 求婚。我们建议的研究是严格测试系统更改方法，以增加对 在缓刑和假释中使用随机化的1型混合实施-有效性设计 网站。我们提出了一个由7个地理位置不同的社区监督(缓刑和 来自罗德岛、北卡罗来纳州和宾夕法尼亚州的表演地点。在6个月后 比较基准，探索、准备、实施、可持续框架是 用于通过促进的当地变革团队来指导系统变革，该团队由司法部和 社区服务提供者。向所有站点提供了一套核心实施战略。整体而言 目标是改善与对涉及司法的个人的循证护理的连续不断的联系。 组织评估与EPIS阶段一起计时。实施结束时，N=680 缓刑/假释犯将被随机分配到接受同伴支持专家与没有同伴的情况下 在3个月、6个月和12个月时提供支持和随访。实施结果包括计划的可接受性、 采用率、渗透率、可持续性和成本。客户级别的有效性结果包括保留、 满意度、阿片类药物使用、阿片类药物过量、再犯、与OUD治疗的联系以及对 恢复服务。该研究团队正准备评估实施情况，并 Moud在涉及司法的个人中的影响，以回答紧急公共卫生问题 意义，告知实施科学，并改进服务提供。

Abstract Individuals who have been previously incarcerated have a significantly higher risk of dying from overdose; particularly in the first two weeks after release. More than 4.5 million people is the US are supervised in the community setting and nearly half have a substance use disorder but few receive services. There is a critical need for linkage to medication for opioid use disorder (MOUD) for individuals on community supervision. Providing medication for opioid use disorder (MOUD) to individuals on probation or parole decreases the rate of relapse and recidivism, and increases retention in substance abuse treatment. In 2016, RIDOC introduced the first correctional system-wide MOUD program in the country to initiate a comprehensive program to offer all three FDA approved medications (in all prison or jail settings) to all eligible individuals. As a result of the RIDOC program, we have expanded MOUD linkage to treatment in the community that is associated with a significant drop in statewide overdose deaths post-release. This work is the foundation from which we have built the current proposal. Our proposed research is to rigorously test a systems-change approach for increasing use of MOUD using a randomized type 1 hybrid implementation-effectiveness design in probation and parole sites. We propose a unique network of 7 geographically distinct community supervision (probation and parole) performance sites from Rhode Island, North Carolina, and Pennsylvania. After a 6-month period of baseline for comparison, the Exploration, Preparation, Implementation, Sustainability framework is used to guide systems-change through facilitated local change teams consisting of justice and community service providers. A core set of implementation strategies is provided to all sites. The overall objective is to improve linkage to the continuum of evidence-based care for justice-involved individuals. Organizational assessments are timed with EPIS stages. At the end of Implementation, N=680 probation/parolee clients will be randomly assigned to receive peer support specialists vs. no peer support with follow-up at 3, 6 and 12 months. Implementation outcomes include program acceptability, adoption, penetration, sustainability and costs. Client-level effectiveness outcomes include retention, satisfaction, opioid use, opioid overdoses, recidivism, linkage to OUD treatment, and utilization of recovery services. This research team is uniquely poised to evaluate the implementation and impact of MOUD among justice-involved individuals, to answer questions of urgent public health significance, inform implementation science, and improve service delivery.