Evaluation of Kentucky Access to Recovery Linkage Strategy

CDC国家卫生统计中心（NCHS）估计，在截至2015年的12个月期间， 2021年9月，美国有99，543例药物过量死亡。肯塔基州第二 2020年美国年龄调整药物过量致死率最高（51.5例死亡/10万人）。到 为了解决药物过量死亡人数高的问题，需要采取有效的战略， 治疗或尚未接受康复支持服务（RSS）治疗的非法SUD患者， 保持恢复，减少重新使用非法药物和药物过量。恢复访问 (ATR)是一项由药物滥用和精神卫生服务管理局支持的联系战略 （SAMHSA）由肯塔基州于2019年实施，将弱势群体与阿片类药物和/或 使用凭证系统将SUD刺激到RSS，并在恢复 物质使用。肯塔基州ATR（KATR）战略是一个25个县的计划，连接县居民在或 低于200%的国家贫困水平，患有非法SUD并正在接受治疗或早期康复， 以证据为基础的RSS，如恢复住房，和其他RSS。KATR设置的优先级KATR客户端是 涉及司法、退伍军人、孕妇/产后和育儿人群。为了解决以下方面的差距， RSSs的可及性经常发生在弱势群体中，KATR联系方法使用 作为联系战略的代金券，适用于没有其他资金选择的SUD治疗人员， 获取关键RSS。因此，KATR通过代金券的联系是联系的“最后手段”。 RSS本提案的目的是对最后一项建议进行严格的过程和结果评估。 通过实现以下具体目标链接的度假券战略：具体目标1：进行 对KATR连接策略进行评估，以确定KATR策略是否可接受， 向与RSS有联系的非法SUD弱势群体提供;确定障碍和促进因素 评估KATR战略按设计执行的程度。 具体目标2：对肯尼亚、泰国、泰国和泰国的联系战略进行成果和影响评价。具体目标3： 评价在人口中实施代金券作为联系战略的长期效果 在没有其他资金来源时需要RSS。将使用受试者内设计来检验 KATR代金券联系方法在降低非致命和致命过量风险方面的有效性 通过增加个人的恢复资本;减少非法药物使用的恢复;以及促进 重新链接到RSS，如果非法物质使用恢复。研究结果可能会增强当前状态的ATR， 服务于经历类似SUD健康获取差异的个人。

The CDC National Center for Health Statistics (NCHS) estimates that for the 12-month period ending September 2021 in the United States, (US) there were 99,543 drug overdose deaths. Kentucky had the 2nd highest age-adjusted drug overdose fatality rate (51.5 deaths/100,000 persons) in the US in 2020. To address the high numbers of drug overdose fatalities, effective strategies are needed to link persons in SUD treatment or those with illicit SUD not yet in treatment with recovery support services (RSSs) to build and maintain recovery, and reduce resumption of illicit substance use and drug overdoses. Access to Recovery (ATR) is a linkage strategy supported by Substance Abuse and Mental Health Services Administration (SAMHSA) that was implemented by Kentucky in 2019 to link vulnerable populations with opioid and/or stimulant SUDs to RSSs using a voucher system and re-link clients to RSSs following resumption of substance use. The Kentucky ATR (KATR) strategy is a 25-county program that links county residents at or below the 200% national poverty level who have illicit SUDs and are in treatment or early recovery to evidence-based RSSs such as recovery housing, and to other RSSs. Priority KATR clients set by KATR are justice-involved, veteran, pregnant/ postpartum, and parenting populations. To address the gap in accessibility of RSSs that often occurs in vulnerable populations, the KATR linkage approach uses vouchers as a linkage strategy for individuals in SUD treatment who have no other funding options to acquire critical RSSs. As such, KATR’s linkage through vouchers is a “last resort” approach for linking to RSSs. The purpose of this proposal is to perform a rigorous process and outcome evaluation of this last resort voucher strategy of linking by accomplishing the following specific aims: Specific Aim 1: Conduct a process evaluation of the KATR linkage strategy to determine whether the KATR strategy is acceptable and accessible to vulnerable populations with illicit SUD who are linked to RSSs; identify barriers and facilitators to KATR implementation; and assess the extent to which the KATR strategy was implemented as designed. Specific Aim 2: Conduct an outcome and impact evaluation of the KATR linkage strategy. Specific Aim 3: Evaluate the long-term effectiveness of implementing vouchers as a linkage strategy in a population requiring RSSs when no other funding sources are available. A within-subjects design will be used to test the effectiveness of the KATR voucher linkage approach to reducing the risk of nonfatal and fatal overdoses by increasing an individual’s recovery capital; reducing resumption of illicit substance use; and promoting relinking to RSSs if illicit substance use is resumed. Study results may enhance current state ATRs that serve individuals experiencing similar SUD health access disparities.