Knock and Talk: Public Health-Public Safety Partnerships for Post-Overdose Outreach and Prevention

敲门说话：公共卫生与公共安全伙伴关系，促进服药过量后的外展和预防

• 批准号: 9894696
• 负责人: Alexander Yale Walley
• 金额: $ 74.82万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2021-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9894696
• 关键词: Knock; Talk; Public; Health; Safety

Project Summary/Abstract: Non-fatal opioid overdose is the strongest predictor of a subsequent fatal overdose. Thus, a non-fatal overdose offers a pivotal opportunity to engage the survivor in harm reduction and/or treatment services to reduce the likelihood of a future fatal overdose. “Knock and Talk” programs are emerging secondary prevention interventions designed to reduce the risk of a future overdose in survivors. Although they differ widely, these programs share three common characteristics: 1) a collaboration between first responders (fire, police and/or emergency medical services) and public health programs (harm reduction, addiction treatment and/or mental health providers); 2) community-based outreach following a nonfatal overdose; and 3) linking of survivors to treatment and overdose prevention services. Since 2015, Knock and Talk (KT) programs have proliferated to more than 60 Massachusetts municipalities. KT programs can promote better outcomes by minimizing the stigma experienced by people who use opioids, reducing overdose risk behaviors, increasing the likelihood of a naloxone rescue, and motivating survivors to enter care. The emergence of KT programs in some Massachusetts municipalities, but not others, affords an unprecedented opportunity to conduct a natural experiment to evaluate the effectiveness of these interventions. Further, the opportunity exists to identify best practices, unintended consequences, implementation barriers and facilitators, and to develop evidence-informed guideline recommendations for these programs. Thus, the specific aims of this proposal are: 1) To complete a comprehensive inventory, including key characteristics, of Massachusetts KT programs using a statewide survey of local public safety and public health agencies; 2) To identify best practices, unintended consequences, and implementation barriers and facilitators using direct observation of KT encounters and qualitative interviews with front line staff and recipients of KT services in a subsample of 20 representative KT programs; 3) To determine the effectiveness of KT programs in reducing opioid overdoses by comparing a) municipalities with and without KT programs and b) municipalities with and without selected key characteristics among KT programs, using interrupted time- series analyses; and 4) To develop KT program guideline recommendations useful to public health and public safety agencies, based on findings from Aims 1-3 and a review of the literature, using a modified Delphi process with a distinguished panel of public health and public safety experts. To accomplish the proposed mixed methods research, we have assembled a highly qualified and accomplished multidisciplinary team with expertise in developing and implementing these partnerships, quasi- experimental causal inference approaches, quantitative survey and formative qualitative methods, and public health law, policy and ethics. We will develop practical and evidence-informed guideline recommendations for public health and public safety agencies implementing and sustaining KT programs.

项目摘要/摘要：非致死性阿片类药物过量是随后致死性阿片类药物过量的最强预测因子。 服药过量因此，非致命性过量提供了一个关键的机会，使幸存者参与减少伤害 和/或治疗服务，以减少未来致命过量的可能性。“敲门和谈话”节目是 旨在降低幸存者未来过量用药风险的新兴二级预防干预措施。 虽然它们有很大的不同，但这些计划有三个共同的特点：1） 第一响应者（消防、警察和/或紧急医疗服务）和公共卫生计划（减少伤害， 成瘾治疗和/或心理健康提供者）; 2）在非致命性 过量;和3）将幸存者与治疗和过量预防服务联系起来。自2015年以来，Knock和 谈话（KT）计划已经扩散到马萨诸塞州的60多个城市。KT计划可以 通过最大限度地减少阿片类药物使用者所经历的耻辱，减少过量使用， 风险行为，增加纳洛酮救援的可能性，并激励幸存者进入护理。 KT计划在马萨诸塞州的一些城市出现，但不是其他城市，提供了一个 这是一个前所未有的机会，可以进行自然实验来评估这些方法的有效性。 干预措施。此外，还有机会确定最佳做法、意外后果， 实施障碍和促进因素，并制定循证指南建议， 这些节目。因此，本建议的具体目标是：1）完成一份全面的清单， 包括关键特征，马萨诸塞州KT计划使用全州范围内的当地公共安全调查， 公共卫生机构; 2）确定最佳做法、意外后果和实施障碍 和促进者使用直接观察KT遭遇和与一线工作人员的定性访谈， 接受KT服务的20个代表性KT计划的子样本; 3）为了确定 通过比较a）有和没有KT计划的市政当局， B）在KT方案中具有和不具有选定关键特征的城市，使用中断时间- 系列分析;以及4）制定对公共卫生和公众有益的KT计划指南建议 安全机构，基于目标1-3的结果和文献综述，使用改进的德尔菲程序 与一个由公共卫生和公共安全专家组成的杰出小组合作。 为了完成所提出的混合方法研究，我们组建了一个高素质的， 在发展和实施这些伙伴关系方面具有专门知识的多学科团队，准 实验因果推理方法，定量调查和形成性定性方法，以及公众 卫生法律、政策和道德。我们将制定实用和循证的指南建议， 公共卫生和公共安全机构实施和维持KT计划。