Alliance to Disseminate Addiction Prevention and Treatment (ADAPT): A Statewide Learning Health System to Reduce Substance Use among Justice-Involved Youth in Rural Communities.

项目摘要 青少年司法系统（YJJ）中的青少年特别容易受到阿片类药物相关伤害， 他们的精神健康和物质使用障碍（SUD）的高比率与从未 被捕了虽然存在SUD的循证干预措施（EBI），但一般很少有年轻人，YJJ 具体来说，访问EBI。这在农村环境中尤其困难， 专家、获得交通和其他资源的机会有限以及征聘和留住人才方面的挑战 对行为健康护理提出了额外的障碍。在阿片类药物危机期间，这一困难变得更加复杂， 青少年使用阿片类药物在农村地区更为普遍，因为那里有机会进行药物使用治疗， 严重缺乏。具体来说，印第安纳州的行为健康治疗提供者数量排名第46位， 成瘾的人。受资助的家长赠款、传播预防吸毒联盟和 治疗（ADAPT），旨在提高农村YJJ治疗的临床疗效。具体来说，父母 格兰特采用了学习健康系统模型，以发展青少年司法系统之间的联盟， 在8个农村县的社区精神卫生中心（CMHC），并实施捆绑治疗方法， 改善SUD的EBI使用。本多样性补充文件建议以两种方式扩大这项工作。一是 将描述农村CMHC中SUD的EBI特征，包括提供的服务和涉及的劳动力。我们 将对农村CMHC的工作人员和领导进行定性访谈，以确定用于以下方面的具体策略： 在农村环境中实施SUD的EBI，描述所涉及的提供者及其在实施这些措施中的作用 任务，并定义所确定的服务交付模型的基本原理。其次，我们将比较青年SUD 在更多的农村地区和较少的农村地区提供的服务和所涉及的劳动力。使用链接 来自青少年司法机构的行政数据，CMHC访问和医疗补助保险索赔， 县，我们将描述与SUD EBI实施相关的服务和劳动力变量，以及 比较较少农村地区和较多农村地区的可持续发展服务。该项目的成果将提供更全面的 了解当前SUD治疗实践的情况，并指导农村环境中未来的EBI。具体而言，结果将告知 利用非专业卫生工作者、病例管理者和同伴康复的未来护理研究任务转移模式 教练在农村CMHC中忠实地提供EBI。

PROJECT SUMMARY Youth who are involved in the juvenile justice system (YJJ) are at particular risk for opioid-related harms, given their high rates of mental health and substance use disorders (SUDs) compared to youth who have never been arrested. Although evidence-based interventions (EBIs) for SUDs exist, few youth in general, and YJJ specifically, access EBIs. This is a particular difficulty in rural settings, where shortages of behavioral health specialists, limited access to transportation and other resources, and recruitment and retention challenges present additional barriers to behavioral health care. This difficulty is compounded during the opioid crisis, as adolescent use of opioids is more prevalent in rural areas where opportunities for substance use treatment are severely lacking. Indiana, specifically, ranks 46th in number of behavioral health treatment providers per individuals suffering addictions. The funded parent grant, Alliances to Disseminate Addiction Prevention and Treatment (ADAPT), seeks to improve the clinical efficacy of treatment for rural YJJ. Specifically, the parent grant employs a Learning Health System model to develop alliances between the juvenile justice system and community mental health centers (CMHCs) in 8 rural counties and implement a bundled treatment approach to improve use of EBIs for SUDs. This Diversity Supplement proposes to expand this work in two ways. First, we will characterize EBIs for SUDs in rural CMHCs, including the services provided and the workforce involved. We will conduct qualitative interviews with staff and leaders at rural CMHCs to identify specific strategies used to implement EBIs for SUDs in rural settings, describe the providers involved and their roles in implementing these tasks, and define the rationale for the identified service-delivery model. Second, we will compare the youth SUD services provided and the workforce involved across more rural and less rural settings. Using linked administrative data from juvenile justice agencies, CMHC visits, and Medicaid insurance claims in participating counties, we will describe service and workforce variables relevant to the implementation of EBIs for SUDs, and compare SUD services between less rural and more rural areas. The results of this project will provide a fuller picture of current SUD treatment practices and guide future EBIs in rural settings. Specifically, results will inform future task-shifting model of care research to leverage lay health workers, case managers, and peer recovery coaches in the delivery of EBIs with fidelity in rural CMHCs.