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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：患有阿片类药物使用障碍 (OUD) 可以使寻找和维持就业变得更加困难重大挑战，并且在 COVID-19 环境中只会变得更糟。各州报告失业率高达 15-20%，失业对 OUD 治疗结果的负面影响是预计会恶化。 COVID-19 大流行进一步导致治疗中断，由于失业、社会孤立、无法获得药物而加剧了不良结果 OUD 治疗 (MOUD)，以及干扰为许多人提供必要结构的日常生活与沉香木。我们小组进行的研究表明个人安置和支持 (IPS) 是有效的为患有创伤后压力的退伍军人带来更多的工作周数和更高的稳定就业率患有各种精神疾病（包括药物滥用）的退伍军人在初级保健机构接受治疗；然而，人们对其对 OUD 退伍军人的功效知之甚少。只有一个小的使用 OUD 对平民（n = 45）进行了研究，其中 50% 分配给 IPS 的参与者获得了 6 个月随访时，就业率与候补名单对照的 5% 相比 (p<0.001)。系统回顾 IPS 对严重精神疾病以外的疾病的有效性揭示了主要局限性研究较多，包括样本量小、IPS模型重大修改、控制弱、随访时间短期间。针对从 OUD 中恢复的退伍军人进行的 IPS 大型随机对照试验，随访时间更长期间，强有力的治疗控制和严格遵守 IPS 保真度（例如我们建议的那样）是必要的。方法：这是一项前瞻性、多中心、随机对照试验，旨在确定 IPS 的疗效比较 120 名退伍军人接受非 IPS 常规职业康复治疗 (TAU-VR) OUD（目标 1）。研究人员推测，接受 OUD 随机分配到 IPS 的退伍军人的工作效率会显着提高与非 IPS TAU-VR 组相比，在超过 15 个月的竞争性工作中工作了几周。另外，相比非 IPS TAU-VR，IPS 接收者将从竞争性工作中获得显着更多的收入，并且显着实现稳定就业的可能性更大。研究人员还将评估自我报告的弹性指标，生活质量、感知压力、社区参与、抑郁、焦虑、禁欲自我效能和自杀风险。作为目标 2，研究人员使用基于社区的参与式研究 (CBRP) 方法将确定为退伍军人提供职业服务的背景障碍和促进因素 IPS 和非 IPS TAU-VR 研究部门，包括评估就业挑战、最佳职业功能和 OUD 治疗依从性，特别强调 COVID-19 和社会的影响疏远。为了实现目标 2，调查人员将通过 OUD 对退伍军人进行半结构化访谈随机分配至 IPS 或非 IPS TAU-VR。这些访谈将得到来自以下机构的定性调查结果的补充：正在进行的康复研发试点研究，包括与 IPS 专家就同一主题进行定性访谈，提供者、拥有 OUD 的失业退伍军人以及潜在雇主。与 CBPR 指导委员会合作，研究结果将被汇总，以便就在这一新人群中实施 IPS 的最佳实践达成共识。在探索性目标 3 中，将比较 IPS 与非 IPS TAU-VR 对参与者遵守情况的影响 MOUD 和 OUD 复发率。意义：本研究旨在寻找成功康复和功能重新融入的最佳干预措施适合从 OUD 中恢复的退伍军人。考虑到 COVID-19 的社会影响，这项研究显得尤为及时大流行对普通民众，特别是退伍军人的就业和心理健康问题造成了影响。此外，新的 VHA 计划将支持性就业服务扩大到吸毒退伍军人未来几年的疾病，我们的研究是及时的，可以为解决问题所需的证据做出重大贡献在这一新的优先人群中成功实施和维持支持性就业服务。