Improving Retention across the OUD Service Cascade upon Re-entry from Jail using Recovery Management Checkups

7.摘要 监狱为干预患有阿片类药物使用障碍(OUD)的个人提供了一个最佳环境，因为 吸毒犯罪者的数量，以及他们在释放阿片类药物后复发的高风险 社区。当务之急是将OUD患者与社区基础药物辅助治疗联系起来 在他们重返大气层时接受治疗(MAT)，以及为他们正在进行的治疗保留和 恢复。这项拟议的实验将测试循证干预的改编版本，即 恢复管理检查(RMC)模式，提供季度检查和协助 治疗保留和重新联系，如季度体检所示。RMC改编的将调整 根据个人评估的治疗需要进行检查的频率和强度，从而减少 (或延长)那些有(或没有)治疗需要指标的人进行检查的间隔时间。这个 拟议的实验将比较治疗联系和保留率以及公共卫生和公共卫生 750名男性和女性罪犯出狱后随机分为3组： A)像往常一样重新进入(控制)，b)原始RMC，以及c)为参与者量身定制的RMC自适应版本 需要治疗。这项研究将与伊利诺伊州的6个县监狱和MAT合作进行 目前为患有OUD的罪犯提供释放前和释放后垫子的提供商。发布前，参与者将 接受OUD病史和MAT资格筛查。所有参与者都将接受研究后续访谈 每季度进行一次，为期两年，其中还将包括尿液测试和记录检查(治疗、死亡率、再犯率)。 本研究的目的是评估：(1)RMC和/或RMC自适应对OUD服务的直接影响 级联护理(启动、参与、保留、重新联系和数月的MAT参与)；(2)间接 RMC和/或RMC适应性(通过参加MAT的几个月)对公共卫生结果的影响(天数 阿片类药物的使用、OUD症状、生活质量和医疗费用)；(3)RMC的间接影响 和/或RMC-适应(通过数月的MAT和公共卫生结果)公共安全结果(非法 活动、再次逮捕、再次监禁和犯罪成本)；和(4) 控制组与RMC组与RMC组--在两种公共健康结果(阿片类药物使用天数、质量)方面都是适应性的 调整后的寿命年[QALYs]、卫生保健使用成本)和公共安全结果(再次监禁和 犯罪成本)。这项研究将确定根据个人的治疗需求量身定做体检是否会导致 更有效地将资源定向到有需要的人，减轻低收入者的干预负担 需要，并导致改善RMC检查的整体效果和成本效益。

7. Abstract Jails provide an optimal setting for intervening with individuals with opioid use disorders (OUD), given the high volume of offenders with OUD, and their high risk of relapse to opioids following their release to the community. It is imperative that individuals with OUD are linked to community-based medication assisted treatment (MAT) upon their re-entry, as well as receive support for their ongoing treatment retention and recovery. The proposed experiment will test an adapted version of an evidence-based intervention, the Recovery Management Checkups (RMC) model, which provides quarterly check-ups and assistance with treatment retention and re-linkage as indicated at the quarterly check-ups. The RMC-Adapted will adjust the frequency and intensity of check-ups based on the individual’s assessed need for treatment, thereby reducing (or lengthening) the time between check-ups for those with (or without) indicators of treatment need. The proposed experiment will compare treatment linkage and retention rates as well as public health and public safety outcomes of 750 male and female offenders randomly assigned to 1 of 3 groups upon release from jail: a) a re-entry as usual (control), b) the original RMC, and c) a RMC-Adaptive version tailored to the participant’s need for treatment. The study will be conducted in collaboration with 6 county jails in Illinois and the MAT providers that currently provide pre- and post-release MAT to offenders with OUD. Pre-release, participants will be screened for history of OUD and eligibility for MAT. All participants will receive research follow-up interviews quarterly for 2 years, which will also include urine testing and records checks (treatment, mortality, recidivism). The study aims are to evaluate: (1) the direct effects of RMC and/or RMC-Adaptive on the OUD service cascade of care (initiation, engagement, retention, re-linkage, and months of MAT participation); (2) the indirect effects of RMC and/or RMC-Adaptive (via months of MAT participation) on public health outcomes (days of opioid use, OUD symptoms, quality of life and the cost of health-care utilization); (3) the indirect effects of RMC and/or RMC-Adaptive (via months of MAT and public health outcomes) on public safety outcomes (illegal activity, re-arrest, re-incarceration, and cost of crime); and (4) the incremental costs and cost-effectiveness of the control vs. RMC vs. RMC-Adaptive in terms of both public health outcomes (days of opioid use, quality adjusted life years [QALYs], cost-of-health-care utilization) and public safety outcomes (re-incarceration and cost of crime). The study will determine if tailoring the checkups to individual’s need for treatment leads to more efficient targeting of resources to those in need, reduces the intervention burden on those with lower need, and results in an improved overall effectiveness and cost-effectiveness of RMC checkups.