Pilot Implementation of Measurement-Based Care in Community Opioid Treatment Programs

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PROJECT SUMMARY Opioid overdose has been recognized as a public health emergency, as lethal drug overdoses have become the leading cause of accidental death in the United States. The gold standard, evidence-based intervention for opioid use disorder is pharmacotherapy, but abstinence rates following pharmacotherapy are sub-optimal. Measurement-based care (MBC), the systematic use of client self-report data to inform and enhance treatment, is an evidence-based intervention that could be uniquely well suited to complement pharmacotherapy for OUD. Unfortunately, very few community opioid treatment programs (OTPs) offer psychosocial interventions to complement pharmacotherapy due to the high volume of patients served and a reliance on group therapy models to accommodate this large census. There is a pressing need for flexible psychosocial intervention structures for use in OTPs that are not associated with typical barriers found in full package, manualized interventions. The training and research activities in this proposal seek to enhance the provision of MBC in community OTPs through two research phases bolstered by four training aims. In Phase 1 of the research plan, the candidate, supported by the experienced mentorship team, will work with 8 OTPs to develop community-engaged research partnerships, complete site visits, and engage treatment providers, leaders, staff, and patients in qualitative interviews and quantitative surveys. Phase 1 outcomes will be used to inform site selection for MBC implementation and to facilitate adaptation of an MBC assessment protocol for use in OTPs. Phase 2 will involve a pilot type I hybrid effectiveness-implementation study with four OTPs. The candidate will work with the OTPs to integrate MBC into electronic medical record documentation procedures. Treatment providers will also receive MBC training and ongoing support, and preliminary MBC effectiveness and implementation data will be collected. To conduct this research, the candidate requires training in four key areas: 1) development and management of community-engaged partnerships to support effectiveness and implementation trials in addiction treatment; 2) training in evidence-based assessment and intervention methods for OUD; 3) training in mixed methods data collection using rapid ethnography; and 4) training in measure design and adaptation. These training aims will be supported by the Brown University Center for Alcohol and Addiction Studies as well as by the candidate’s mentorship team. The mentorship team will be led by Primary Mentor Dr. Sara Becker, an expert in implementation science and community partnership development in substance use treatment settings. The proposal will also be supported by Dr. Francesca Beaudoin, Dr. Lawrence Palinkas, and Dr. Melissa Clark, experts in OUD intervention, rapid mixed methods data collection, and measure design, respectively. Taken together, this research and career development plan will advance a significant public health issue by enhancing the quality of OUD care while launching the independent career of the candidate in the implementation of MBC in OTPs.