Supporting Treatment Access and Recovery through Linkage and Support (STAR-LS)

项目总结/摘要 在美国，成瘾是一个日益严重的公共卫生问题，近2100万美国人 物质使用障碍（SUD）标准，160万人符合阿片类药物使用障碍（OUD）标准，阿片类药物- 在过去5年中，相关的过量用药增加了50%。在SUD患者中，49%的人患有共病 心理健康障碍（COD）。COD患者容易复发，精神疾病 病情加重、过量用药、无家可归和刑事司法介入。然而，尽管高利率 发病率，死亡率和广泛的社会决定因素的健康需求与COD的人，只有8%的 在美国，人们接受了精神疾病和SUD的治疗。在那些有COD接收的人中， 治疗，6个月的参与率低至16%的心理治疗，90%的个人， 离开治疗将在12周内复发。马萨诸塞州也受到严重打击，SUD患病率高出16 与美国相比，而马萨诸塞州的第二大城市伍斯特受到的影响尤为严重 由SUD，具有最高的过量服用率在国家之一，并在CDC的社会脆弱性排名第二 指数.这些发现强调了改善治疗途径和参与以支持康复的必要性。 伍斯特，马萨诸塞州。链接和多组件环绕模型作为一种 解决方案，以增加治疗的机会和参与。保持独立和清醒，通过 系统集成、推广和联网（使命）是一种混合型多组件联系和处理方法， 方法，提供与心理社会治疗相结合的坚定的外联联系支持，由一个 跨学科团队使命与社会生态模型（SEM）保持一致，以解决多层次客户端问题 通过三个基于证据的实践需求。它们包括1）关键时间干预（CTI），一种有时间限制的形式， 2）双重康复疗法（DRT），即COD的综合团体治疗; 3）朋辈支援（Peer Support，PS），由康复中的人为康复中的人提供支援。关于RFA- CE-22-010，拟定的3年混合I型研究，“通过以下方式支持治疗获取和恢复 链接和支持（STAR-LS），”将招募和随机化208例COD患者在伍斯特，马萨诸塞州， 枢纽，由伍斯特卫生和人类服务部运行的一个项目，符合以下条件之一：1）使命; 或2）同伴支持（仅链接）。具体目标有三个：目标1：评估 使命或比较同伴支持，以改善参与，物质使用和心理健康症状。 目标2：研究干预措施的作用机制。目的3：进行序贯混合方法 过程评估，为可持续性和未来的实施提供信息。该提案与CDC的 战略优先领域和健康人2030核心目标，因为它旨在改善行为健康 结果加强和维持COD患者的恢复生态系统。

PROJECT SUMMARY / ABSTRACT Addiction is a growing public health problem in the United States (U.S.), with nearly 21 million Americans meeting criteria for substance use disorder (SUD), 1.6 million meeting criteria for opioid use disorder (OUD), and opioid- related overdoses have increased by 50% over the past 5 years. Among people with SUD, 49% have comorbid mental health disorders (COD). Individuals with COD are vulnerable to substance use relapses, mental illness exacerbations, overdoses, homelessness, and criminal justice involvement. However, despite the high rates of morbidity, mortality, and broad social determinant of health needs among people with COD, only 8% of individuals in the U.S. received treatment for both mental illness and SUD. Among those with a COD receiving treatment, 6-month engagement rates are as low as 16% for psychosocial treatments, and 90% of individuals leaving treatment will relapse within 12 weeks. Massachusetts is also hard hit, with a 16% higher SUD prevalence compared to the U.S., and Worcester, the second largest city in Massachusetts, is disproportionately affected by SUD, having one of the highest overdose rates in the state and is ranked 2nd on the CDC social vulnerability index. These findings highlight the need to improve treatment access and engagement to support recovery in Worcester, Massachusetts. Both linkage and multicomponent wraparound models have gained popularity as a solution to increase treatment access and engagement. Maintaining Independence and Sobriety through Systems Integration, Outreach and Networking (MISSION) is a hybrid multicomponent linkage and treatment approach, providing assertive outreach linkage support combined with psychosocial treatment, delivered by a cross disciplinary team. MISSION is aligned with the Social Ecological Model (SEM) to address multilevel client needs via 3 evidence-based practices. They include 1) Critical Time Intervention (CTI), a time-limited form of assertive community treatment; 2) Dual Recovery Therapy (DRT), which is integrated group therapy for COD; and 3) Peer Support (PS), offering support for people in recovery by people in recovery. In response to RFA- CE-22-010, the proposed 3-year Hybrid Type I study, “Supporting Treatment Access and Recovery through Linkage and Support (STAR-LS),” will recruit and randomize 208 patients with COD in Worcester, MA in the Hub, a program run by the Worcester Health and Human Services to one of the following conditions: 1) MISSION; or 2) Peer Support (linkage only). There are three specific aims: Aim 1: To evaluate the effectiveness of MISSION or compared to Peer Support to improve engagement, substance use and mental health symptoms. Aim 2: To examine mechanisms of action of the interventions. Aim 3: To conduct a sequential mixed methods process evaluation to inform sustainability and future implementation. This proposal is aligned with CDC’s Strategic Priority Areas and Health People 2030 Core Objectives as it intends to improve behavioral health outcomes strengthen and sustain the recovery ecosystem for people with COD.