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: 10022112
• 负责人: KYM R AHRENS
• 金额: $ 60.63万
• 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 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10022112
• 关键词: Address; Adolescent; Adolescent and Young Adult; Alcohol or Other Drugs use; Assertiveness; Award; Back; Biometry; Caring; Clinical Trials; Collaborations; Communities; Cost Analysis; Cost Savings; Cost-Benefit Analysis; Costs and Benefits; Country; Criminal Justice; Custom; Data; Data Collection; Data Reporting; Economics; Effectiveness; Ensure; Epidemic; Evidence based intervention; Frequencies; Future; Grant; Health; Infrastructure; Institution; Interruption; Intervention; Justice; Measures; Methods; Modeling; Opioid; Outcome; Overdose; Participant; Patient Self-Report; Pediatric Hospitals; Phase; Population; Prevention; Prevention strategy; Preventive Intervention; Procedures; Protocols documentation; Psychological reinforcement; Recording of previous events; Rehabilitation therapy; Research Personnel; Resources; Rewards; Risk; Risk Factors; Sampling; Self Administration; Sequential Multiple Assignment Randomized Trial; Substance Use Disorder; Surveys; System; Trauma; Universities; University Hospitals; Urine; Washington; Youth; adaptive intervention; aged; base; contingency management; cost; cost effective; cost effectiveness; cost outcomes; disorder prevention; effective intervention; effectiveness evaluation; experimental study; high risk; improved; innovation; motivational enhancement therapy; non-opioid analgesic; opioid use; opioid use disorder; prevent; primary outcome; programs; recidivism; recruit; reduced substance use; retention rate; secondary outcome; social; substance use prevention; treatment as usual; trial design

PROJECT SUMMARY Non-prescription opiate use in adolescents and young adults is epidemic in our country and overdose-related fatalities are rising. Adolescents and young adults in justice settings (AYAJS) have some of the highest rates of opioid use disorder (OUD), with national rates approaching 20%. The majority of AYAJS engage in problematic non-opioid substance use, which is a critical risk factor for OUD. Non-opioid substance use disorders (SUDs) and OUD, in turn, are two of the most important predictors of subsequent re-involvement in juvenile or criminal justice systems. Seattle Children’s Hospital (SCH), University of Washington (UW), and Washington State Juvenile Rehabilitation (WSJR) will collaboratively evaluate OUD prevention interventions of varying intensities based on the Adolescent Community Reinforcement Approach with Assertive Continuing Care (ACRA/ACC). Multiple studies have established effectiveness of ACRA/ACC in reducing SUD; however none have evaluated it as an OUD prevention strategy. SUD is incredibly common and costly among AYAJS; thus ACRA/ACC- based approaches are likely to be effective and cost-beneficial OUD prevention strategies for this group. However, we need to determine the optimal intensity of an ACRA/ACC-based OUD prevention intervention for AYAJS with and without non-opioid SUD, as these groups are likely to have differing prevention needs. We will use Sequential Multiple Assignment Randomized Trial (SMART) to construct high-quality adaptive interventions (AIs) containing ACRA/ACC-based OUD prevention strategies of different intensity levels among SUD and non-SUD youth. In our 2-year UG3 phase, we will collaboratively plan for a SMART experiment, i.e.: finalize infrastructure, recruitment, intervention, and data collection procedures; and create infrastructure for sustainable future implementation of effective interventions after the UH3 full trial (UG3 Aim 1). We will conduct a pilot with 40 AYAJS to assess feasibility of protocols and procedures, recruitment, engagement, and retention strategies in anticipation of full trial (UG3 Aim 2). In our 3-year UH3 phase, we will conduct a SMART trial with 430 AYAJS aged 16-25 from all WSJR institutions to evaluate ACRA/ACC-based OUD prevention interventions of various intensity levels among SUD and non-SUD youth (UH3 Aim 1). We will administer self- report electronic surveys at baseline, 1, 3 & 6 months to collect cost and outcomes 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, others); we will use administrative data to measure recidivism. Our UH3 Aim 2 will be to conduct comprehensive cost analyses to estimate the resources required to implement our ACRA-based interventions. Our proposal is responsive to the RFA, innovative in its degree of partnership with WSJR as well as in its rigorous and pragmatic SMART design. It is also high impact in that it is highly likely to prevent OUD for one of the most vulnerable youth populations in our country.

项目摘要 非处方优化在青少年和年轻人中的使用在我国是流行病，并且与用药相关 死亡人数正在增加。司法环境中的青少年和年轻人（ayajs）的比率是 Opioid使用障碍（OUD），全国利率接近20％。大多数AYAJs从事有问题的问题 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（SUDS） 反过来，Oud是随后重新参与少年或刑事的两个最重要的预测指标 司法系统。西雅图儿童医院（SCH），华盛顿大学（UW）和华盛顿州 少年康复（WSJR）将协作评估不同强度的预防干预措施 基于青少年的社区加强方法，并具有自信的持续护理（ACRA/ACC）。 多项研究已经确定了ACRA/ACC在减少SUD方面的有效性；但是没有评估 它是一种预防策略。 SUD在AYAJS中非常普遍且昂贵。因此acra/acc- 基于基于的方法可能是该组有效和成本效益的OUD预防策略。 但是，我们需要确定基于ACRA/ACC的OUD预防干预的最佳强度 有或没有非阿片类SUD的AYAJ，因为这些群体可能有区分预防需求。我们将 使用顺序多重分配随机试验（SMART）来构建高质量的自适应 干预措施（AIS）包含不同强度水平的基于ACRA/ACC的OUD预防策略 SUD和非幼年青年。在我们两年的UG3阶段，我们将合作计划进行智能实验，即： 最终确定基础设施，招聘，干预和数据收集程序；并为 UH3全面试验后，可持续实施有效干预措施（UG3 AIM 1）。我们将进行 一名拥有40个AYAJ的飞行员，以评估协议和程序，招聘，参与度的可行性 预期全面试验的保留策略（UG3 AIM 2）。在我们三年的UH3阶段，我们将进行聪明 所有WSJR机构的430名AYAJS年龄为16-25岁，以评估基于ACRA/ACC的OUD预防 SUD和非SUD青年之间各种强度水平的干预措施（UH3 AIM 1）。我们将管理自我 在基线上报告电子调查，1、3和6个月，以收集有关主要结果的成本和结果数据 （根据天数和任何物质使用频率衡量的使用和升级）和 次要结果（包括阿片类药物在内的特定物质的天数/使用频率，其他物质）； 将使用管理数据来衡量累犯。我们的UH3 AIM 2将是进行全面的成本 分析以估计实施基于ACRA的干预措施所需的资源。我们的建议是 响应RFA，与WSJR的合作程度以及严格的和 务实的智能设计。这也是很大的影响，因为它极有可能阻止OUD最多 我国脆弱的青年人口。