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INDIVIDUAL PLACEMENT AND SUPPORT FOR VETERANS WITH OPIOID USE DISORDER: A MIXED METHODS STUDY

对患有阿片类药物使用障碍的退伍军人的单独安置和支持：混合方法研究

基本信息

批准号：
10701819
负责人：
LORI L. DAVIS
金额：
--
依托单位：
TUSCALOOSA VETERANS AFFAIRS MEDICAL CTR
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-10-01 至 2026-09-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10701819
关键词：
Abstinence Address Adherence Anxiety Area Back COVID-19 COVID-19 impact COVID-19 pandemic COVID-19 pandemic effects Communities Consensus Control Groups Data Deterioration Diagnosis Economic Burden Economics Effectiveness Employment Environment Evaluation Feeling hopeless General Population Goals Homelessness Income Individual Interruption Intervention Interview Link Measures Mental Depression Mental Health Mental disorders Methods Modeling Modification Occupational Occupations Outcome Participant Patient Self-Report Persons Pilot Projects Population Post-Traumatic Stress Disorders Poverty Prevention Process Productivity Provider Psyche structure Public Health Publishing Quality of life Randomized Randomized, Controlled Trials Recovery Rehabilitation therapy Relapse Reporting Research Research Personnel Research Support Resources Sample Size Sampling Self Efficacy Services Site Social Distance Social isolation Socialization Specialist Structure Substance Use Disorder Supported Employment Symptoms Treatment outcome Unemployment Veterans Vocation Vocational rehabilitation Waiting Lists Work arm community based participatory research community engagement design effectiveness evaluation efficacy evaluation efficacy testing evidence base experience follow-up functional independence implementation evaluation implementation facilitators improved interest medication for opioid use disorder methadone treatment opioid epidemic opioid use disorder patient population perceived stress primary care setting prospective rehabilitation service relapse prevention research and development resilience rural area substance use success suicidal risk systematic review treatment adherence treatment as usual

项目摘要

Background: Living with an opioid use disorder (OUD) can make finding and sustaining employment a significant challenge and is only getting worse in the COVID-19 environment. With states reporting unemployment rates as high as 15-20%, the negative effects of unemployment on OUD treatment outcomes are expected to deteriorate. The COVID-19 pandemic has further resulted in treatment disruptions that are exacerbating poor outcomes, because of unemployment, social isolation, interrupted access to medication for OUD treatment (MOUD), and interference of daily routines that provide the necessary structure for many people with OUD. Our group has conducted research that shows Individual Placement and Support (IPS) is efficacious in yielding more weeks worked and higher steady employment rates for Veterans with posttraumatic stress disorder and Veterans diagnosed with a broad range of mental conditions (including substance use) being treated in a primary care setting; however, little is known about its efficacy in Veterans with OUD. Only one small study in civilians (n=45) with OUD has been conducted, in which 50% of the participants assigned to IPS gained employment compared to 5% of waitlist control at 6 months follow-up (p<0.001). A systematic review of effectiveness of IPS with conditions other than serious psychiatric mental illness revealed major limitations in many studies, including small sample sizes, major modifications to IPS model, weak control, and short follow-up periods. A larger randomized controlled trial of IPS for Veterans recovering from OUD with longer follow-up period, strong treatment control, and strict adherence to IPS fidelity, such as the one we propose, is warranted. Methods: This is a prospective, multi-site, randomized controlled trial to determine the efficacy of IPS compared to non-IPS Treatment-as-Usual Vocational Rehabilitation (TAU-VR) in a sample of 120 Veterans recovering from OUD (Aim 1). Investigators hypothesize that Veterans with OUD randomized to IPS will work significantly more weeks in a competitive job over 15 months compared to the non-IPS TAU-VR group. Additionally, compared to non-IPS TAU-VR, IPS recipients will earn significantly more income from competitive jobs and be significantly more likely to achieve steady employment. The investigators will also evaluate self-report measures of resilience, quality of life, perceived stress, community engagement, depression, anxiety, abstinence self-efficacy and suicide risk. As Aim 2, using a Community Based Participatory Research (CBRP) approach, the investigators will identify the contextual barriers to and facilitators of implementing vocational services for Veterans in both the IPS and non-IPS TAU-VR study arms, including evaluation of employment challenges, optimal occupational functioning, and OUD treatment adherence, with specific emphasis on the impact of COVID-19 and social distancing. To address Aim 2, the investigators will conduct semi-structured interviews with Veterans with OUD randomized to IPS or non-IPS TAU-VR. These interviews will be supplemented by qualitative findings from an ongoing Rehabilitation R&D pilot study that includes qualitative interviews on the same topic with IPS specialists, providers, unemployed veterans with OUD, and potential employers. Working with a CBPR Steering Committee, findings will be aggregated to reach consensus on best practices for IPS implementation in this new population. In an Exploratory Aim 3, the impact of IPS will be compared to non-IPS TAU-VR on participants’ adherence to MOUD and rates of OUD relapse. Significance: This study seeks to find the best intervention for successful recovery and functional reintegration for Veterans recovering from OUD. This study is especially timely given the societal impact of the COVID-19 pandemic on employment and mental health problems of the general population, and Veterans specifically. Additionally, with the new VHA plan to expand supported employment services to Veterans with substance use disorders in the coming years, our study is timely and can significantly contribute to the evidence required to successfully implement and sustain supported employment services in this new priority population.

背景：与阿片类药物使用障碍（OUD）一起生活可以使寻找和维持就业成为一种困难