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: 10663762
• 负责人: KYM R AHRENS
• 金额: $ 33.64万
• 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/10663762
• 关键词: Address; Administrative Supplement; Adolescent; Adolescent and Young Adult; Adult; Affect; Age; Assertiveness; Back; Black race; Budgets; COVID-19; Caregivers; Caring; Censuses; Communities; Cost Analysis; Crime; Data; Development; Dose; Drops; Education; Effectiveness; Enrollment; Exclusion Criteria; Feedback; Food; Frequencies; Funding; Goals; Grant; Hispanic; Hybrids; Imprisonment; Incentives; Intervention; Justice; Latinx; Legal system; Length; Measures; Methods; Modeling; National Institute of Drug Abuse; Opioid; Outcome; Participant; Patient Self-Report; Pediatric Hospitals; Persons; Phase; Police; Population; Positioning Attribute; Prevention strategy; Prevention trial; Process; Protocols documentation; Psychological reinforcement; Qualifying; Regulation; Rehabilitation therapy; Research; Research Design; Rewards; Risk; Risk Factors; Sample Size; Self Administration; Sequential Multiple Assignment Randomized Trial; Social Distance; Substance Use Disorder; Surveys; System; Testing; Time; Trauma; Universities; Washington; Work; Youth; adaptive intervention; aged; base; coronavirus disease; cost; court; disorder prevention; experimental study; group intervention; intervention effect; member; motivational enhancement therapy; motivational intervention; non-opioid analgesic; opioid epidemic; opioid overdose; opioid use; opioid use disorder; overdose death; parent grant; participant retention; pilot test; prevent; preventive intervention; primary outcome; programs; recidivism; recruit; reduced substance use; retention rate; secondary outcome; substance use; telehealth; therapy design; trend; trial design; virtual

PROJECT SUMMARY Opiate use and overdose deaths have been rising, especially during COVID. Youth involved with the legal system (YILS) have some of the highest rates of opioid use disorder (OUD); local rates in the Washington State Juvenile Rehabilitation (WSJR) system approach 1 in 3 youth. Nationwide, most YILS engage in problematic non-opioid substance use, a critical risk factor for OUD. Non-opioid substance use disorders (SUDs) and OUDs, in turn, are two of the most important predictors of subsequent re-involvement in juvenile or criminal systems. In a 5-year UG3/UH3 grant, Seattle Children’s Hospital (SCH), University of Washington (UW), and WSJR are collaboratively evaluating OUD prevention interventions of varying intensities based on the Adolescent Community Reinforcement Approach with Assertive Continuing Care (ACRA/ACC). Multiple studies have established ACRA/ACC effectiveness in reducing SUD; however, none have evaluated it as OUD prevention. We are using SMART methods to construct ahigh-quality adaptive intervention (AI) containing ACRA/ACC- based OUD prevention strategies of two different intensities. In our 2-year UG3 phase, we conducted a pilot SMART experiment with 31 YILS. In our 3-year UH3 phase, we are conducting a full SMART trial with YILS aged 15-25 to compared effects of our prevention interventions during the following stages: a) as youth transition out of confinement (stage 1), and b) once they are back in the community (stage 2). We administer self-report electronic surveys at baseline, 1, 3, & 6 months to collect data on primary outcomes (initiation and escalation of use measured by number of days and frequency of use of any substances) and secondary outcomes (number of days/ frequency of use of specific substances including opioids); we will use administrative data to measure recidivism. We are also conducting comprehensive cost analyses. Currently, we have achieved recruitment and retention rates that exceeded our goals as written in the parent grant (72% and 76%). However, due to increasing OUD rates resulting in a smaller proportion of current WSJR YILS qualifying for inclusion in this opioid prevention trial, longer average sentence lengths, and COVID reductions in census, we are recruiting at ~half of the weekly rate we originally anticipated. At the current rates, 187 youth will finish the study. This will allow us to assess stage 1 intervention effects on primary outcomes but could limit our ability to assess stage 1 effects on some secondary outcomes or stage 2 effects. In the present administrative supplement, we seek to mitigate COVID effects on sample size via increased incentives, increased budget for food rewards (which are a standard part of ACRA/ACC), as well as increases in recruiter/surveyor and interventionist FTEs. We seek to boost both recruitment and retention rates to 85%, which will allow us to enroll and retain at least 292 and 248 YILS, respectively. These added participants will increase our power to detect main effects on primary outcomes from 80% to 87 and will provide sufficient power to assess small/moderate stage 1 effects on secondary outcomes and stage 2 effects.

项目总结 鸦片类药物的使用和过量死亡一直在上升，特别是在COVID期间。青少年参与法律事务 系统(YILS)有一些阿片类药物使用障碍(OUD)的最高比率；华盛顿州的当地比率 少年康复(WSJR)系统接近1/3的青年。在全国范围内，大多数YILS从事有问题的 非阿片类药物的使用，这是OUD的一个关键风险因素。非阿片类物质使用障碍(SODS)和ODS， 反过来，也是随后重新参与青少年或犯罪系统的两个最重要的预测因素。在……里面 西雅图儿童医院(SCH)、华盛顿大学(UW)和WSJR提供为期5年的UG3/UH3赠款 基于青少年的不同强度OUD预防干预的协作性评价 积极持续关怀的社区强化方法(ACRA/ACC)。多项研究表明 ACRA/ACC在减少SUD方面的有效性已被证实；然而，没有人将其评估为OUD预防。 我们正在使用智能方法构建一个高质量的适应性干预(AI)，包含ACRA/ACC- 基于两种不同强度的预防策略。在我们为期两年的UG3阶段，我们进行了一个试点 用31个YILS进行智能实验。在我们为期3年的UH3阶段，我们正在对YILS AGE进行全面的智能测试 15-25比较我们在以下阶段采取的预防干预措施的效果：a)作为青年过渡时期退出 (B)一旦他们重返社区(阶段2)。我们管理自我报告 在基线、1个月、3个月和6个月进行电子调查，以收集关于主要结果的数据(启动和升级 使用天数和使用任何物质的频率)和二次结果(数量 天数/包括阿片类药物在内的特定物质的使用频率)；我们将使用行政数据来衡量 累犯。我们也在进行全面的成本分析。目前，我们已经实现了招聘 保留率超过了我们在家长拨款中写下的目标(72%和76%)。然而，由于 提高OUD费率导致当前WSJR YILS有资格被纳入此 阿片类药物预防试验，更长的平均刑期，以及人口普查中COVID的减少，我们正在招募 ~我们最初预期的每周房价的一半。按照目前的速度，187名青年将完成这项研究。这将是 允许我们评估第一阶段干预对主要结果的影响，但可能会限制我们评估第一阶段的能力 对一些次要结果或阶段2的影响。在本行政副刊中，我们力求 通过增加激励措施、增加食品奖励预算(这是 作为ACRA/ACC的标准部分)，以及招聘者/调查员和干预者FTE的增加。我们寻求 将招聘率和留职率都提高到85%，这将使我们能够招收和留住至少292人和248人 YILS。这些增加的参与者将增加我们检测主要影响的能力 80%至87%的结果，并将提供足够的能力来评估对以下方面的小/中阶段1影响 二次结局和第二阶段效应。