Building Social and Structural Connections for the Prevention of OUD among Youth Experiencing Homelessness: An RCT Examining Biopsychosocial Mechanisms

项目总结/摘要 无家可归严重影响健康和福祉，对青年人尤其不利。70-95%的 经历无家可归的青年（YEH）报告有问题的物质使用，66-89%的人有心理健康问题。 disorder.青年人似乎比成年人更有可能流落街头或无家可归， 易受无家可归的长期影响。健康的多种社会决定因素（SDOH） 与无家可归，驾驶物质使用和不良心理健康后果密切相关。 然而，有限的研究已经确定了务实的干预措施，有一个长期的改善影响 这些年轻人中复杂的、多症状的问题。这项研究克服了先前的研究差距， 测试针对SDOH的多成分综合预防干预措施， 生物心理社会健康指标和长期健康结果。与星星之家合作， 一个YEH中心，年龄在14到24岁之间的年轻人，将被雇用并随机分配到条件 使用拆卸设计，以便有效地识别必要的干预组件。特别是， 青年（N = 300）将被随机分配到a）动机访谈/社区强化方法 + 服务作为服务（MI/CRA + SAU，n = 80），B）基于优势的外联和宣传+ SAU（SBOA + SAU，n = 80），c）MI/CRA + SBOA + SAU（n = 80）或d）SAU（n=60）通过随访中心。为了评估 对药物使用、心理健康和其他结果的长期预防效果，所有青年都将 在基线和基线后3、6、12、18和24个月进行评估。本研究的主要目的是 建立嵌入在服务于YEH的系统中的综合干预的影响， 下降中心，对青年的阿片类药物滥用和障碍，其他物质滥用和障碍，心理健康 诊断和其他有针对性的结果。这项研究将提供独特的信息途径的变化 为特定的青年分组提供沿着成本估算，以便为救助中心未来的实施工作提供信息 在全国各地。

Project Summary/Abstract Homelessness severely affects health and well-being and is particularly negative for youth. Between 70-95% of youth experiencing homelessness (YEH) report problem substance use and 66-89% have a mental health disorder. Youth appear to be at greater risk for living on the streets or being homeless than adults and are more vulnerable to long term consequences of homelessness. Multiple social determinants of health (SDOH) are uniquely associated with homelessness, driving substance use and adverse mental health consequences. However, limited research has identified pragmatic interventions that have a long-term ameliorating impact on the complex, multi-symptomatic issues among these youth. This study overcomes prior gaps in research through testing a multi-component comprehensive prevention intervention targeting SDOH that may affect biopsychosocial health indicators and longer-term health outcomes. In partnership with Star House, a drop-in center for YEH, youth between the ages of 14 to 24 years, will be engaged and randomly assigned to conditions using a dismantling design so that essential intervention components can be efficiently identified. In particular, youth (N = 300) will be randomly assigned to a) Motivational Interviewing/Community Reinforcement Approach + Services as Usual (MI/CRA + SAU, n = 80), b) Strengths-Based Outreach and Advocacy + SAU (SBOA + SAU, n = 80), c) MI/CRA + SBOA + SAU (n = 80) or d) SAU (n=60) through the drop-in center. In order to assess the longer-term prevention effects on substance use, mental health and other outcomes, all youth will be assessed at baseline and at 3, 6, 12, 18 and 24-months post-baseline. The primary goal of this study is to establish the impact of a comprehensive intervention embedded within a system that serves YEH, a community drop-in center, on youth’s opioid misuse and disorder, other substance misuse and disorders, mental health diagnoses, and other targeted outcomes. This study will offer unique information on pathways underlying change for specific subgroups of youth along with cost estimates to inform future implementation efforts in drop-in centers around the country.