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

摘要 以前被监禁的人死于癌症的风险要高得多。 特别是在释放后的前两周。美国有450多万人， 在社区环境中受到监督，近一半的人患有物质使用障碍，但很少有人接受 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 社区监督。向个人提供阿片类药物使用障碍（MOUD）的药物， 缓刑或假释降低了复吸率和累犯率，并增加了物质上的保留 虐待治疗2016年，RIDOC推出了第一个惩教系统范围的MOUD计划， 国家启动一项全面的计划，提供所有三种FDA批准的药物（在所有监狱或 监狱设置）给所有符合条件的个人。由于RIDOC计划，我们扩大了MOUD 与社区治疗的联系与全州范围内的 释放后过量死亡这项工作是我们建立当前 提议我们提出的研究是严格测试一个系统的变化方法，以增加使用 MOUD在缓刑和假释中使用随机类型1混合实施效果设计 网站.我们提出了一个独特的网络7地理上不同的社区监督（缓刑和 来自罗得岛、北卡罗来纳州和宾夕法尼亚州的表演场地。六个月后 作为比较基准，探索、准备、实施和可持续性框架 用于通过由司法人员和 社区服务提供者。向所有地点提供了一套核心实施战略。整体 目标是改善与为涉及司法的个人提供的循证护理的连续性的联系。 组织评估与EPIS阶段同步进行。实施结束时，N=680 缓刑/假释客户将被随机分配接受同行支持专家与没有同行 在3个月、6个月和12个月时提供随访支持。实施结果包括方案的可接受性， 采用、渗透、可持续性和成本。客户一级的有效性成果包括保留， 满意度，阿片类药物使用，阿片类药物过量，累犯，与OUD治疗的联系，以及 恢复服务。这个研究小组是唯一准备评估的实施， MOUD在涉及司法的个人中的影响，以回答紧迫的公共卫生问题 重要性，通知实施科学，并改善服务提供。

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.