Developing and Testing Innovative Care Pathways for Screening and Treatment of OUD/PTSD in Jails

开发和测试监狱中 OUD/PTSD 筛查和治疗的创新护理途径

• 批准号: 10812703
• 负责人: Nickolas D Zaller
• 金额: $ 91.56万
• 依托单位: UNIV OF ARKANSAS FOR MED SCIS
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10812703
• 关键词: Address; Adoption; Adult; Arkansas; Caring; Cause of Death; Clinical Trials; Communities; Consolidated Framework for Implementation Research; Criminal Justice; Data; Disease; Disparity; Drug usage; Effectiveness; Elements; Eligibility Determination; Enrollment; Evaluation; Evidence based intervention; Female; Goals; Healthcare; Helping to End Addiction Long-term; Hybrids; Imprisonment; Individual; Intervention; Interview; Jail; Justice; Link; Measures; Mental Health; Methods; Modeling; National Institute of Drug Abuse; Opioid; Outcome; Participant; Pathway interactions; Patients; Persons; Phase; Post-Traumatic Stress Disorders; Prisons; Provider; Quality of Care; Randomized; Records; Research; Research Support; Sampling; Services; Severities; Source; Strategic Planning; Surveys; Symptoms; Testing; Translating; Treatment outcome; United States National Institutes of Health; Victimization; Vision; Vulnerable Populations; Work; brief intervention; comorbidity; design; effectiveness evaluation; effectiveness outcome; effectiveness-implementation RCT; effectiveness/implementation design; evidence base; experience; implementation evaluation; implementation outcomes; implementation science; improved; improved outcome; innovation; medication for opioid use disorder; meetings; novel; novel strategies; operation; opioid overdose; opioid use disorder; research to practice; response; scale up; screening; screening, brief intervention, referral, and treatment; secondary outcome; violence victimization

Project Summary Opioid overdose is the leading cause of death among people recently released from incarceration. Yet, while there is growing research on opioid use disorder (OUD) and medications for OUD (MOUD) in jails and prisons, studies find that few people who are referred to post-release community MOUD initiate treatment. Emerging research suggests that therapy for posttraumatic stress disorder (PTSD), a common and deleterious OUD comorbidity, could profoundly increase the likelihood of MOUD engagement; however, this has not been tested in jails and considerable work to first tailor PTSD screening and treatment to jails and to people with OUD/PTSD in this setting would be required. Therefore, this 6-year R61/R33 aims to develop and test innovative approaches to PTSD screening and treatment among people who are eligible for jail-based OUD services. In the R61, we will form a coalition of carceral, community, and academic stakeholders to collaboratively adapt the Screening, Brief Intervention, and Referral to Treatment model to the jail context and to the needs of jailed adults with OUD/PTSD (SBIRT-J). In the R33, we will 1) assess the implementation outcomes of SBIRT-J for linking jailed adults with OUD/PTSD to therapy for PTSD via a summative evaluation guided by the Consolidated Framework for Implementation Research and 2) assess the effectiveness and implementation outcomes of competing models of PTSD therapy timing. To evaluate the latter, we will use a patient-randomized Hybrid type I implementation-effectiveness design in which jailed adults identified as having OUD/PTSD through the SBIRT-J model are randomly assigned to either immediate initiation of therapy for PTSD in jail or initiation of PTSD therapy upon release. Our primary effectiveness outcome will be post- release MOUD initiation at 6-months post-release from jail; secondary outcomes will include MOUD retention, OUD severity, PTSD symptoms, victimization, and additional drug use. Participants in the effectiveness portion of the trial (N = 304; 50% female) will be enrolled from the largest jail in Arkansas. Importantly, our study vision aligns with NIDA's Strategic Plan, as we aim to “support research to scale up the application of evidence- based interventions for SUDs, including in justice settings” (Goal 4.3). Our overall goal is to translate research to practice to increase the provision of high-quality care for justice-involved persons with OUD, consistent with the goals of NIH's HEAL Initiative. Indeed, this study will be the first trial of a treatment for PTSD in jails as a method for improving OUD outcomes, providing foundational information on PTSD as a novel intervention target for meeting the needs of a particularly vulnerable population and providing the implementation data to inform rapid scale-up if effective.

项目摘要 阿片类药物过量是最近获释的人的主要死亡原因。然而，虽然 在监狱和监狱中，关于阿片使用障碍(OUD)和OUD药物(Moud)的研究越来越多， 研究发现，很少有人被转到出院后社区接受治疗。新兴 研究表明，治疗创伤后应激障碍(PTSD)是一种常见而有害的疾病 合并症，可能会大大增加Moud参与的可能性；然而，这还没有经过测试 在监狱和相当大的工作中，首先为监狱和患有创伤后应激障碍的人量身定制创伤后应激障碍筛查和治疗 需要此设置中的OUD/PTSD。因此，这款6年期R61/R33旨在开发和测试 对符合入狱条件的人进行创伤后应激障碍筛查和治疗的创新方法 服务。在R61中，我们将组成一个监狱、社区和学术利益相关者联盟，以 协作调整筛查、简短干预和转诊到治疗模式，以适应监狱环境和 对患有创伤后应激障碍的被监禁成年人的需求(SBIRT-J)。在R33中，我们将1)评估实施情况 SBIRT-J通过终结性评估将患有OUD/PTSD的入狱成年人与PTSD治疗联系起来的结果 在实施研究综合框架的指导下，2)评估有效性和 创伤后应激障碍治疗时机竞争模式的实施结果。为了评估后者，我们将使用 患者-随机混合I型实施有效性设计，在该设计中，被监禁的成年人被识别为 通过SBIRT-J模型的OUD/PTSD患者被随机分配到立即开始治疗的组 监狱中的创伤后应激障碍或在获释后开始创伤后应激障碍治疗。我们的主要成效成果将是-- 在出狱后6个月释放穆德入会；次要结果将包括保留穆德， 创伤后应激障碍的严重程度、创伤后应激障碍症状、受害情况和额外的药物使用。有效性部分的参与者 审判的一部分(N=304；50%是女性)将从阿肯色州最大的监狱登记。重要的是，我们的研究愿景 与NIDA的战略计划保持一致，因为我们的目标是“支持扩大证据应用的研究-- 以肥皂剧为基础的干预，包括在司法环境中“(目标4.3)。我们的总体目标是将研究成果转化为 实践，以增加对涉及正义的人的高质量照顾，符合 美国国立卫生研究院医治计划的目标。事实上，这项研究将是监狱中创伤后应激障碍治疗的第一次试验 用于改善OUD结果的方法，提供作为一种新干预的创伤后应激障碍的基础信息 满足特别易受伤害人口的需求并向其提供执行数据的目标 如果有效，通知快速扩展。