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.

总结/摘要 参与法律的系统的青年是一个易受伤害的群体，他们使用药物的比例很高， 服药过量由于强制禁欲和随之而来的较低的耐受率，过量的风险是50倍 在释放后的头两周，被监禁者的死亡率高于一般人群。在全国范围内， 与非法生产芬太尼和其他合成阿片类药物的频率上升相对应， 吸毒过量的风险急剧增加风险因素也在发生变化。以前，使用高效 类阿片和类阿片或多种物质使用障碍是青少年/年轻成人用药过量的关键风险因素。 目前，只有三分之一的致命过量的年轻人以前使用过阿片类药物。在华盛顿州 儿童、青年和家庭青少年康复部（DCYF JR）系统几乎三分之一的青少年在 我们的国营设施符合阿片类药物使用障碍的标准，58%的青少年接受了药物使用筛查 这些病症表明他们在过去的某个时候服用过量，但没有致命。我们寻求进行一个混合的 方法研究，对YILS可改变的过量风险因素进行三角识别，制定策略， 衡量这一风险，并制定和测试多层次干预措施，以减少这一风险。我们预计， 教育、经证实的减少危害策略和提高行为动机的策略相结合 将是减少被监禁青少年吸毒过量风险的最有效方法。虽然这一提议是 针对特定的高风险人群（被监禁的青少年），我们将制定预防过量用药的策略 这可以在其他人群中复制，解决我们国家最关键的公共卫生问题之一。 在目标1中，我们将对接触过量的青少年进行定性的个人半结构化访谈 （20-30）;工作人员和医务人员等内部利益攸关方（10-15）; 研究或政策专长（5-10）。在目标2中，我们将对行政管理进行横向评估， DCYF JR数据用于识别与既往用药过量事件相关的可修改风险降低因素。在目标3中， 将根据先前的目标开发多层次预防干预数据。我们期待包括教育 活动/举措、纳洛酮和芬太尼测试条分发、激励性面试以发展 过量预防目标和增强动力，以执行这些目标，并短信提醒 件.我们将用20 DCYF JR测试需要改进的干预措施的具体组成部分 青年，在未来的随机对照试验（RCT）的预期。最后，我们将探讨数据关联 在DCYF JR和其他管理数据系统之间，以确定是否有可能预测 在2个系统中，经历致命或接近致命过量的青少年最有可能与系统发生相互作用 用药过量事件发生前几个月该提案符合NIDA的HEAL倡议和战略计划， 将减少我国最脆弱的青少年吸毒过量的风险。