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

基本信息

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
项目类别：
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

项目摘要

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.

项目摘要使用使用和过量用药死亡正在增加，尤其是在库维德期间。青年参与法律系统（YIL）具有阿片类药物使用障碍（OUD）的最高率；华盛顿州的当地利率少年康复（WSJR）系统方法1中有3名青年。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的关键危险因素。非阿片类药物使用障碍（SUD）和OUDS，反过来，随后在少年或犯罪系统中重新参与的最重要的两个预测指标。华盛顿大学（UW）和WSJR的5年UG3/UH3 Grant，西雅图儿童医院（SCH）根据青少年进行协作评估不同强度的OUD预防干预措施通过自信持续护理（ACRA/ACC）的社区加强方法。多个研究有在减少SUD方面已建立了ACRA/ACC效力；但是，没有人将其评估为预防。我们正在使用智能方法来构建包含ACRA/ACC-的Ahigh质量自适应干预措施（AI）两种不同强度的基于OUD预防策略。在我们两年的UG3阶段，我们进行了一个飞行员智能实验31 yils。在我们三年的UH3阶段，我们正在与YILS老年进行全面的智能试验 15-25比较以下阶段的预防干预措施的影响：a）年轻人过渡囚禁（第1阶段），b）一旦他们回到社区（第2阶段）。我们管理自我报告基线时的电子调查，1、3和6个月，以收集有关主要结果的数据（启动和升级使用按天数和任何物质使用频率衡量的）和次要结果（数字包括阿片类药物在内的特定物质的天数/使用频率）；我们将使用管理数据来衡量累犯。我们还正在进行全面的成本分析。目前，我们已经取得了招聘保留率超出了父母赠款中我们所写的目标（72％和76％）。但是，由于提高OUD速率，导致较小比例的当前WSJR YIL符合条件的资格阿片类药物预防试验，较长的平均句子长度和人口普查的降低，我们正在招募〜我们最初预期的每周费率的一半。以目前的速度，187名青年将完成这项研究。这会允许我们评估1阶段的干预对主要结果的影响，但可能会限制我们评估1阶段的能力对某些次要结果或第二阶段效应的影响。在目前的行政补充中，我们寻求通过增加激励措施，增加食品奖励的预算（即 ACRA/ACC）的标准部分，以及招聘人员/测量师和干预主义者的增加。我们寻求将招聘和保留率提高到85％，这将使我们能够注册和保留292和248 分别分别。这些增加的参与者将增加我们检测主要影响主要影响的能力从80％到87的结果，将提供足够的能力来评估小/中等第1阶段的影响次要结果和第二阶段效应。