Barriers and Facilitators to Implementation of Family-Based Treatment for Opioid Use Disorder in Adolescents and Young Adults

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PROJECT SUMMARY Adolescents and young adults (AYA) have been severely affected by the opioid epidemic. In 2016 alone, over 4,000 AYA died from opioids, totaling 230,694 years of premature life lost. When left untreated or ineffectively treated, AYA with OUD experience an array of negative health outcomes including legal involvement, school dropout, family conflict, sexually transmitted infections, and death. Thus, increasing access to evidence-based treatments for AYA with OUD is a priority of great public health importance. The front-line evidence-based treatment for AYA with symptoms of dependency is pharmacotherapy; however, documented poor abstinence rates and rising overdose rates have highlighted the urgent need to augment pharmacotherapy with behavioral treatment. For AYA, there is critical consensus from multiple national organizations that treatment should use a developmentally sensitive, family-based approach. Family-based treatment approaches (FBT) have been evaluated rigorously, demonstrated effectiveness among AYA (particularly those age 12-20), and are endorsed for use with AYA up to age 25. Yet, the availability of FBT for AYA in community OUD treatment centers remains low. The current study aims to conduct a mixed-methods examination of systems-level barriers and facilitators to implementation of FBT approaches for AYA with OUD in community opioid treatment clinics, theoretically guided by the Consolidated Framework for Implementation Research (CFIR). Building upon the Primary Sponsor’s NIDA-funded parent study, data collection will occur in partnership with 12 opioid treatment centers throughout Rhode Island. Participants will be key informants with the ability to influence services offered within the opioid treatment system including clinic leaders, front-line treatment providers, policy makers, and patient advocates. Comprehensive data collection strategies include in-depth, semi-structured interviews as well as surveys utilizing a combination of validated implementation science measures and items derived from identified themes in qualitative interviews. Knowledge gained will be translated into customized feedback and recommendations about specific implementation strategies for each opioid treatment clinic. Policy makers and advocates will receive a summary of barriers and facilitators throughout the state with recommendations for specific policy actions. A highly structured training plan will ensure execution of the proposed research aims. Specifically, the candidate will receive training in (1) implementation science, (2) OUD in AYA, (3) FBT for AYA, (4) mixed-methods approaches, and (5) advocacy, grant writing, and manuscript preparation. Training will be guided by a stellar mentorship team with highly relevant expertise and long-standing track records of successful mentorship. The proposed research and training plan is further supported by the rich training environment at the Center for Alcohol and Addiction Studies at Brown University. Combined, the research and training activities will support the candidate’s pursuit of a clinical research career focused on facilitating the implementation of evidence-based interventions for AYA with OUD.