Alliance to Disseminate Addiction Prevention and Treatment (ADAPT): A Statewide Learning Health System to Reduce Substance Use among Justice-Involved Youth in Rural Communities.

项目摘要 印第安纳州在全国药物过量死亡人数中排名第14位，从2016年到2017年， 过量死亡增加（22.5%）。疾病预防控制中心最近报告说，印第安纳州是仅有的六个州之一， 因疑似阿片类药物过量而到急诊室就诊的人数显著增加。然而，胡赛尔人面临着 阿片类药物滥用和其他物质使用障碍（SUD）不太可能获得必要的服务;印第安纳州- 一个主要是农村的州-在每个遭受痛苦的人的行为健康治疗提供者数量方面排名第46位 上瘾通过针对中西部州的农村县，我们的研究团队寻求解决全国性的 阿片类药物危机的中心。我们还将重点关注阿片类药物相关风险最高的人群。 危害：青少年司法系统中的青少年（YJJ）。在被捕的青少年中，78%最近使用非法药物， 物质.我们的研究表明，YJJ的死亡率是从未被捕的年轻人的1.5倍， YJJ的死因之一是吸毒过量我们提议的项目的主要目标是， 传播成瘾预防和治疗（ADAPT），旨在解决有效SUD治疗的障碍 的YJJ，如通过物质使用护理级联确定的。我们将通过建立联盟来实现目标 在印第安纳州的10个农村地区， 个县这些合作的JJ-CMHC伙伴关系将促进SUD风险识别和服务 JJ的连接，并能够及时启动和参与由JJ提供的循证SUD治疗 CMHC。适应行动采取双管齐下的办法。首先，我们将采用学习健康系统（LHS）模型 建立强生和CMHC之间的联盟。第二，我们将最大限度地预防阿片类药物的使用， 实施捆绑治疗方法，以改善筛查、资源分配、劳动力发展 以及针对一系列SUD风险水平的循证干预措施（EBI）。我们假设adapt - LHS联盟和有针对性的SUD EBI的传播相结合-将对SUD产生积极影响， 随着时间的推移，累犯的结果。我们将进行混合II型比较有效性，随机分组 临床试验，以比较LHS的EBI干预。此外，我们将采用先进的 方法，如序贯多分配随机试验（SMART）设计，并利用我们的 在将来自多个卫生和司法系统的行政数据联系起来以评估这些结果方面，我们 将利用我们在实施科学，基于社区的研究，临床试验，成本， 有效性研究，并连接行政数据库，以研究评估这些影响 对犯罪累犯和药物使用结果的干预，包括向阿片类药物使用障碍的过渡 和鸦片过量我们希望该项目将指导今后针对该物质的社区努力 在弱势群体中使用护理级联。

PROJECT SUMMARY Indiana ranks 14th nationally in drug overdose deaths and, from 2016 to 2017, experienced the 3rd largest increase (22.5%) in overdose deaths. The CDC recently reported Indiana as one of only six states with a significant increase in emergency department visits for suspected opioid overdose. Yet, Hoosiers at risk for opioid misuse and other substance use disorders (SUDs) are unlikely to receive necessary services; Indiana - a largely rural state - ranks 46th in number of behavioral health treatment providers per individuals suffering addictions. By targeting rural counties in a Midwest state, our research team seeks to address the national opioid crisis at its epicenter. We will also focus on a population among those at greatest risk for opioid-related harms: youth involved in the juvenile justice system (YJJ). Among arrested youth, 78% have recently used illicit substances. Our research has shown that YJJ die at 1.5 times the rate of youth who have never been arrested, and a leading cause of YJJ death is drug overdose. The primary goal of our proposed project, Alliances to Disseminate Addiction Prevention and Treatment (ADAPT), is to address barriers to effective SUDs treatment of YJJ as identified by the substance use care cascade. We will accomplish our goal by creating alliances between the juvenile justice system (JJ) and community mental health centers (CMHCs) in 10 rural Indiana counties. These collaborative JJ-CMHC partnerships will facilitate SUD risk identification and service connection by JJ and enable timely initiation and engagement in evidence-based SUD treatment provided by CMHCs. ADAPT takes a two-pronged approach. First, we will employ a Learning Health System (LHS) model to develop alliances between JJ and CMHCs. Second, we will maximize opioid use prevention efforts by implementing a bundled treatment approach to improve screening, resource allocation, workforce development and evidence-based interventions (EBIs) that target a range of SUD risk levels. We hypothesize that ADAPT – a combination of the LHS alliances and dissemination of targeted SUD EBIs – will positively affect SUD and recidivism outcomes over time. We will conduct a hybrid type II comparative effectiveness, cluster randomized clinical trial to compare the LHS to the EBI interventions. In addition, we will employ sophisticated methodology, such as a sequential multiple assignment randomized trial (SMART) design, and leverage our expertise in linking administrative data from multiple health and justice systems, to assess these outcomes. We will utilize our expertise in implementation science, community-based research, clinical trials, cost- effectiveness research, and linking administrative databases, for research to assess the impact of these interventions on criminal recidivism and substance use outcomes, including transition to opiate use disorders and opiate overdose. We expect this project will guide future community-based efforts targeting the substance use care cascade among vulnerable populations.