Facilitating Opioid Care Connections: System level strategies to improve use of MAT and movement through the opioid care cascade for defendants in a new Opioid Court system

促进阿片类药物护理联系：系统级策略，通过新阿片类药物法院系统中的被告的阿片类药物护理级联，改善 MAT 的使用和行动

• 批准号: 9978018
• 负责人: KATHERINE S ELKINGTON
• 金额: $ 195.38万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-15 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9978018
• 关键词: Abstinence; Address; Adoption; Affect; Age; Buffaloes; Caring; Cause of Death; Charge; Clinical Research; Clinical effectiveness; Communities; County; Development; Diagnosis; Drug Courts; Effect Modifiers (Epidemiology); Effectiveness; Enrollment; Evaluation; Evidence based treatment; Gender; Goals; Guidelines; Health; Health Services Accessibility; Imprisonment; Intervention; Justice; Link; Mediator of activation protein; Methods; Modeling; Movement; New York; Opioid; Outcome; Overdose; Pharmaceutical Preparations; Pharmacotherapy; Population; Practice Guidelines; Preparation; Process; Provider; Public Health; Randomized; Readiness; Research; Resources; Safety; Schedule; Service delivery model; Service provision; Supervision; System; Testing; Theory of Change; Time; Use Effectiveness; Work; aged; community setting; cost effectiveness; cost-effectiveness evaluation; court; demographics; design; disorder risk; economic evaluation; effectiveness implementation study; evidence base; flexibility; implementation science; implementation strategy; improved; innovation; member; model building; model design; multidisciplinary; opioid epidemic; opioid misuse; opioid overdose; opioid use; opioid use disorder; overdose risk; prescription opioid; recidivism; response; safety outcomes; scale up; screening; social cognitive theory; success; treatment as usual; treatment response

In the context of a nationwide opioid epidemic, rates of opioid use (OU), opioid use disorder (OUD) and overdose (OD) disproportionately affect those in the justice system. Yet despite such high rates of OU and OUD, screening for and use of evidence-based treatments for OU and OUD, including medication to treat OUD (MOUD), are substantially underused in justice populations. Courts are an ideal point of intervention in the justice system to identify OU or OUD, and OD risk, and link defendants to treatment/MOUD in the community. However, less than 5% of defendants with drug problems are served by drug treatment courts. In response to the opioid crisis in New York State (NYS), where the propose project will take place, the Unified Court System (UCS) developed a new treatment court model – the opioid court model (OCM) - designed around 10 practice guidelines to address the flaws of existing drug courts and reduce OD, OUD, and recidivism via rapid screening and linkage to MOUD. In 2018, NYS began to expand the OCM across NYS with 9 “initial adopter” counties. Yet, given the innovation of the OCM, the exact barriers to implementation in disparate counties with a range of resources – and the strategies to overcome them – are largely unknown. We propose to integrate evidence-based implementation strategies to refine and evaluate OCM RISE, an implementation intervention that will allow the OCM, as framed by the 10 practice guidelines, to be scaled up across NYS. This UG1 proposal is from three PIs with complimentary expertise in the justice system, implementation science and developing treatment for OUD and its delivery in community settings, and is supported by a strong multi-disciplinary team to achieve study aims. Guided by Exploration Preparation Implementation Sustainment (EPIS) model and Social Cognitive Theory (SCT), Specific Aims are: 1) To refine OCM RISE using formative work with “initial adopter” counties that (a) identifies gaps in service provision by documenting OCM/opioid cascade outcomes; (b) identifies successes/challenges in operationalizing guidelines; and (c) characterizes the working relationships between county opioid court and treatment systems. 2). In a stepped-wedge design in 10 new counties compared to baseline treatment as usual (drug courts), to test, (a) the implementation impact of OCM RISE in improving implementation outcomes along the opioid cascade (screening/identification, referral, treatment enrollment, MOUD initiation); and (b) the clinical and cost effectiveness of OCM RISE in improving public health (treatment retention/court graduation) and public safety (recidivism) outcomes, exploring moderators: defendant gender, age, charge; county urbanicity and county OD rates. 3) To characterize and compare advancement through the stages of implementation of the OCM in the 10 new adopter counties, elucidating the inner- and outer-level EPIS- and SCT-derived factors that influence delivery of implementation strategies to inform OCM scale up; and (b) to explore the relationship between implementation stage completion and all opioid cascade, public health and public safety outcomes.

在全国阿片类药物流行的背景下，阿片类药物使用率 (OU)、阿片类药物使用障碍 (OUD) 和过量 (OD) 对司法系统中的人员产生不成比例的影响。然而，尽管 OU 和 OUD 率如此之高，筛查 OU 和 OUD 的循证治疗方法和使用，包括治疗 OUD 的药物 (MOUD) 司法人口中的利用严重不足。法院是干预司法系统的理想场所 识别 OU 或 OUD 以及 OD 风险，并将被告与社区中的治疗/MOUD 联系起来。然而，小于 5% 有毒品问题的被告由毒品治疗法庭提供服务。为应对阿片类药物危机 拟议项目将在纽约州 (NYS) 进行，统一法院系统 (UCS) 制定了 新的治疗法庭模式——阿片类药物法庭模式（OCM）——设计了大约 10 项实践指南来解决 现有毒品法庭的缺陷，通过快速筛查和与 MOUD 的联动，减少 OD、OUD 和累犯。 2018 年，纽约州开始将 OCM 扩展到整个纽约州的 9 个“初始采用者”县。然而，考虑到创新 OCM 的具体实施障碍，以及在拥有各种资源的不同县实施的具体障碍 克服这些问题的策略在很大程度上是未知的。我们建议整合基于证据的实施 完善和评估 OCM RISE 的策略，这是一种实施干预措施，将允许 OCM 按照框架 制定了 10 项实践指南，并将在整个纽约州推广。该 UG1 提案来自三位 PI，其中 在司法系统、实施科学和发展 OUD 治疗方面的免费专业知识和 它在社区环境中进行，并得到强大的多学科团队的支持以实现研究目标。 以探索准备实施维持（EPIS）模型和社会认知理论为指导 (SCT)，具体目标是： 1) 通过与“初始采用者”县的形成性工作来完善 OCM RISE，这些县 (a) 通过记录 OCM/阿片类药物级联结果来确定服务提供方面的差距； (b) 确定 实施指南的成功/挑战； (c) 描述了之间的工作关系 县阿片类药物法院和治疗系统。 2）。在 10 个新县的阶梯楔形设计中，与 像往常一样进行基线治疗（毒品法庭），以测试 (a) OCM RISE 在改善 阿片类药物级联的实施结果（筛查/识别、转诊、治疗登记、 MOUD启动）； (b) OCM RISE 在改善公共卫生方面的临床和成本效益（治疗 保留/法院毕业）和公共安全（累犯）结果，探索主持人：被告性别， 年龄、费用；县城市化率和县 OD 率。 3) 描述和比较进步 OCM 在 10 个新采用县的实施阶段，阐明了内部和外部 EPIS SCT 衍生因素影响实施策略的交付，以告知 OCM 规模扩大； (b) 至 探索实施阶段完成与所有阿片类药物级联、公共卫生和 公共安全成果。