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

传播成瘾预防和治疗联盟 (ADAPT)：一个全州范围的学习健康系统，旨在减少农村社区参与司法的青少年的药物使用。

• 批准号: 10610536
• 负责人: Matthew Aalsma
• 金额: $ 12.12万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 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 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10610536
• 关键词: Address; Adolescent; Affect; Biological Models; Caring; Centers for Disease Control and Prevention (U.S.); Cessation of life; Charge; Climate; Clinical Trials; Collaborations; Communities; Community Health; Community Mental Health Centers; Continuity of Patient Care; Cost effectiveness research; County; Data; Decision Making; Educational Intervention; Emergency department visit; Ensure; Evidence based intervention; Future; Goals; Health; Health Personnel; Health Services Accessibility; Health system; Human Resources; Hybrids; Indiana; Individual; Infrastructure; Institution; Interdisciplinary Study; Intervention; Justice; Learning; Link; Methodology; Methods; Midwestern United States; National Institute of Drug Abuse; Opioid; Outcome; Overdose; Pharmaceutical Preparations; Policies; Population; Prevention; Public Health; Randomized; Randomized Clinical Trials; Reporting; Research; Research Support; Resource Allocation; Resource-limited setting; Risk; Role; Rural; Rural Community; Sequential Multiple Assignment Randomized Trial; Services; Site; Substance Use Disorder; System; Testing; Time; Training; Treatment Cost; Vulnerable Populations; Work; Workforce Development; Youth; addiction; administrative database; base; behavioral health; community based research; comparative effectiveness; disorder risk; evidence base; experience; implementation cost; implementation evaluation; implementation outcomes; implementation process; implementation science; improved; juvenile justice system; novel; opioid epidemic; opioid misuse; opioid overdose; opioid use; opioid use disorder; overdose death; programs; recidivism; reduced substance use; rural counties; safety outcomes; screening; substance use; success; trial design

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.

项目总结 印第安纳州在全国药物过量死亡人数中排名第14位，从2016到2017年，经历了第三大 服药过量死亡增加(22.5%)。疾控中心最近报告称，印第安纳州是仅有的六个州之一。 疑似阿片类药物过量的急诊科就诊大幅增加。然而，Hoosiers面临着 阿片类药物滥用和其他物质使用障碍(SUDS)不太可能得到必要的服务；印第安纳州- 在一个以农村为主的州，每个人的行为健康治疗提供者的数量排名第46位 上瘾。通过以中西部州的农村县为目标，我们的研究团队寻求解决全国 阿片类药物危机的震中。我们还将重点关注与阿片类药物相关的风险最高的人群 危害：青少年参与少年司法系统(YJJ)。在被捕的年轻人中，78%的人最近使用过非法毒品 物质。我们的研究表明，YJJ的死亡率是从未被逮捕的年轻人的1.5倍， YJJ死亡的一个主要原因是吸毒过量。我们提议的项目的主要目标是，与 传播成瘾预防和治疗(ADAPT)，是为了解决有效肥皂水治疗的障碍 通过物质使用护理级联确定的YJJ。我们将通过建立联盟来实现我们的目标 印第安纳州10个农村的少年司法系统(JJ)和社区精神卫生中心(CMHCs)之间的关系 各县。这些协作的JJ-CMHC合作伙伴关系将促进SUD风险识别和服务 通过JJ建立联系，并能够及时启动和参与由以下机构提供的循证SUD治疗 CMHC。Adapt采取了双管齐下的方法。首先，我们将采用学习健康系统(LHS)模型 发展JJ和CMHC之间的联盟。第二，我们将通过以下方式最大限度地减少阿片类药物的使用 实施捆绑治疗方法，以改善筛查、资源分配、劳动力发展 以及针对各种SUD风险水平的循证干预(EBI)。我们假设适应- LHS联盟和有针对性的SUD EBI的传播相结合-将对SUD和 累犯会随着时间的推移而产生。我们将进行混合类型II比较有效性，整群随机 比较LHS和EBI干预的临床试验。此外，我们将聘请先进的 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成果方面的专门知识。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，并链接行政数据库，以进行研究，以评估这些措施的影响 关于犯罪累犯和药物使用后果的干预措施，包括过渡到阿片类药物使用障碍 以及鸦片类药物过量。我们希望这个项目将指导未来以社区为基础的针对物质的努力 在弱势群体中使用护理瀑布。