Using SMART Design to Identify an Effective and Cost-Beneficial Approach to Preventing OUD in Justice-Involved Youth

使用 SMART 设计确定有效且具有成本效益的方法，以防止参与司法的青少年出现 OUD

• 批准号: 10831796
• 负责人: KYM R AHRENS
• 金额: $ 37.36万
• 依托单位: SEATTLE CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10831796
• 关键词: Abstinence; Address; Administrator; Adolescent; Area; Behavioral; Black race; Child; Child Welfare; Data; Data Linkages; Data Sources; Development; Disease; Education; Ensure; Event; Exposure to; Family; Fentanyl; Frequencies; Future; General Population; Goals; Harm Reduction; Health Personnel; Helping to End Addiction Long-term; Imprisonment; Individual; Information Systems; Intervention; Interview; Justice; Legal system; Link; Measures; Medical; Methods; Motivation; Naloxone; National Institute of Drug Abuse; Nurses; Opioid; Overdose; Overdose reduction; Persons; Pharmaceutical Preparations; Policies; Policy Maker; Population; Preparation; Prevention strategy; Procedures; Provider; Public Health; Qualifying; Randomized, Controlled Trials; Recording of previous events; Rehabilitation therapy; Relapse; Research; Research Personnel; Risk; Risk Assessment; Risk Factors; Risk Reduction; Running; Strategic Planning; Structure; Substance Use Disorder; System; Techniques; Testing; Text Messaging; United States Substance Abuse and Mental Health Services Administration; Vulnerable Populations; Washington; Youth; brief prevention intervention; cost; design; experience; fentanyl test; high risk population; intervention refinement; modifiable risk; motivational enhancement therapy; opioid overdose; opioid use; opioid use disorder; overdose death; overdose prevention; overdose risk; parole; polysubstance use; prevent; preventive intervention; response; screening; substance misuse; substance use; synthetic opioid; test strip; therapy design; trend; young adult

SUMMARY/ABSTRACT Youth involved in legal systems (YILS) are a vulnerable population with high rates of substance use and overdose. Due to forced abstinence and consequent lower tolerance rates, the risk of overdose is 50 times higher for incarcerated persons than the general population in the first two weeks after release. Nationally, commensurate with the rise in frequency of illicitly produced fentanyl and other synthetic opioids, adolescent overdose risk is increasing dramatically. Risk factors are also changing. Previously, prior use of highly potent opioids and opioid or polysubstance use disorder were critical risk factors for adolescent/young adult overdose. Currently only one in three youth that fatally overdoses has used opioids previously. In the Washington State Department of Children, Youth, and Families Juvenile Rehabilitation (DCYF JR) system almost 1 in 3 youth in our state-run facilities qualify as having opioid use disorder, and 58% of youth screened for substance use disorders indicate that they have overdosed non-fatally at some point in the past. We seek to conduct a mixed methods study to triangulate identification of modifiable overdose risk factors for YILS, develop strategies to measure this risk, and develop and test a multilevel intervention to reduce this risk. We anticipate that a combination of education, proven harm reduction strategies, and strategies to increase behavioral motivation will be the most effective way to reduce overdose risk amongst incarcerated youth. Although this proposal is focused on a specific high-risk population (incarcerated youth), we will develop overdose prevention strategies that can be replicated in other populations, addressing one of our nation's most critical public health concerns. In Aim 1 we will conduct qualitative individual semi-structured interviews with youth with exposure to overdose (20-30); internal stakeholders such as staff and medical personnel (10-15); and external stakeholders with research or policy expertise (5-10). In Aim 2 we will conduct a cross-sectional assessment of administrative DCYF JR data to identify modifiable risk reduction factors associated with prior overdose event. In Aim 3 we will develop multilevel preventive intervention data from prior aims. We anticipate including educational campaigns/initiatives, naloxone and fentanyl test strip distribution, motivational interviewing to develop overdose prevention goals and enhance motivation to carry out these goals, and text messaging reminder components. We will test specific components of the intervention in need of refinement with 20 DCYF JR youth, in anticipation of a future randomized controlled trial (RCT). Finally, we will explore data linkages between DCYF JR and other administrative data systems to determine if it is possible to predict which system(s) youth experiencing fatal or near fatal overdose are most likely to have interacted with in the 2 months prior to the overdose event. This proposal is aligned with NIDA's HEAL initiative and strategic plan and will reduce overdose risk among our nation's most vulnerable youth.

摘要/摘要 参与法律制度（YIL）的年轻人是一个脆弱的人口，使用率很高 过量。由于强迫禁欲和随之而来的公差率，过量的风险为50倍 在发布后的前两周，被监禁的人高于一般人群。在全国范围内 与非法产生的芬太尼和其他合成阿片类药物的频率增加相称，青少年 过量的风险正在急剧增加。风险因素也在发生变化。以前，事先使用高度有效 阿片类药物和阿片类药物或多脂肪障碍障碍是青少年/年轻成人过量的关键危险因素。 目前，致命过量服用过量的三分之一的年轻人以前使用了阿片类药物。在华盛顿州 儿童，青年和家庭少年康复（DCYF JR）系统中有几乎三分之一 我们的国有设施有资格患有阿片类药物使用障碍，而58％的青年则被筛查以供药物使用 疾病表明他们过去的某个时候非致敬过量服用过量。我们寻求混合 方法研究以三角鉴定YIL的可修改过量危险因素的鉴定，制定策略 衡量这种风险，并开发和测试多层干预以降低这种风险。我们预计这是 教育的结合，可靠的减少危害策略以及增加行为动机的策略 将是减少被监禁青年过量风险的最有效方法。虽然这个建议是 专注于特定的高风险人群（被监禁的年轻人），我们将制定过量的预防策略 可以在其他人群中复制，这解决了我们国家最关键的公共卫生问题之一。 在AIM 1中，我们将与年轻人进行定性个人半结构化访谈，并暴露于过量 （20-30）;内部利益相关者，例如员工和医务人员（10-15）；以及外部利益相关者与 研究或政策专业知识（5-10）。在AIM 2中，我们将对行政管理进行横断面评估 DCYF JR数据以识别与先前过量事件相关的可修改风险降低因素。在目标3中我们 将从先验目标中开发多级预防性干预数据。我们预计包括教育 运动/计划，纳洛酮和芬太尼测试条分布，动机访谈以发展 过量预防目标并增强执行这些目标的动力，并提醒文字消息传递 成分。我们将测试需要使用20个DCYF JR进行改进的干预措施的特定组成部分 青年期望未来的随机对照试验（RCT）。最后，我们将探索数据链接 在DCYF JR和其他管理数据系统之间，确定是否可以预测 在2种中，最有可能与致命或致命过量过量发生致命或致命过量的系统在2中互动 过量事件之前的几个月。该提案与NIDA的HEAD计划和战略计划保持一致，并且 将减少我们国家最脆弱的青年中的过量风险。