Implementation of Overdose Prevention Practices in Permanent Supportive Housing

项目总结 永久支持性住房(PSH)，结束长期无家可归的黄金标准干预措施，有 近年来在美国各地迅速扩张，并可能继续扩大，因为无家可归者 在新冠肺炎大流行之后增加。由于个人和环境风险的汇合 因素，PSH租户面临过量用药(OD)的高风险。而循证实践(EBPS)则 防止OD的存在，但它们尚未在PSH设置中广泛实施。我们建议解决这个问题 通过为PSH量身定做一套循证的OD预防实践来实践GAP的重大研究 然后研究它们在纽约20栋PSH建筑中的实施情况。我们将测试一套 实施战略，包括实施工具包、租户-员工实施冠军二人组、 有限的练习促进和学习协作。该项目将与 支持性住房公司，这是一个全国性的组织，通过以下方式推动改善PSH的解决方案 教育、实践和政策。目标1是使基于证据的药物过量预防做法适用于PSH，使用KEY 利益攸关方重点小组，并开发PSH药物过量预防工具包以指导实施。在这 准备阶段，我们将考虑到独特的环境，对现有的EBPS方案进行调整 PSH的特点，并将为实施做准备。目标2是评估证据的执行情况- 基于跨不同PSH建筑的OD预防实践以及对PSH租户结果的有效性 阶梯式楔形试验。在这项混合类型3有效性-实施研究中，主要实施 结果是PSH逐渐采用了预防服药过量的EBPS。我们将另外检查第二个 实施结果、租户临床结果和实施维持。目标3是探索 影响执行的多层面因素--包括障碍和促进者--并改进传播和 住房环境的实施框架，使用与私营部门住房和卫生局工作人员的定性访谈。这项研究 借鉴EPIS(探索、准备、实施、维持)实施框架和 罗兹的风险环境框架。研究将通过以下方式为实施框架和战略提供信息 研究EPIS在PSH方面的应用，并测试与住房相关的新实施策略，包括 员工-租户实施冠军二人组。这项以PSH为重点的研究结果预计将是 更广泛地适用于其他类型的住房和为无家可归者提供服务的环境。 多学科调查员团队将与利益攸关方咨询委员会合作，以最大限度地发挥 研究，旨在为地方和国家的方案和政策干预提供信息。 美国OD危机流行病学的变化突显出需要共同努力来减少 特别边缘化人口面临的不同的消耗臭氧层物质负担。

PROJECT SUMMARY Permanent supportive housing (PSH), the gold standard intervention for ending chronic homelessness, has expanded rapidly across the U.S. in recent years and is likely to continue expanding as homelessness increases in the wake of the COVID-19 pandemic. Due to a confluence of individual and environmental risk factors, PSH tenants face heightened risk for overdose (OD). While evidence-based practices (EBPs) to prevent OD exist, they have not been broadly implemented in PSH settings. We propose to address this significant research to practice gap by tailoring a set of evidence-based OD prevention practices for PSH settings, then studying their implementation in 20 PSH buildings in New York. We will test a package of implementation strategies that includes an implementation toolkit, tenant-staff implementation champion dyads, limited practice facilitation, and learning collaboratives. The project will be conducted in partnership with the Corporation for Supportive Housing, a national organization that advances solutions to improve PSH through education, practice, and policy. Aim 1 is to adapt evidence-based OD prevention practices for PSH, using key stakeholder focus groups, and develop a PSH OD Prevention Toolkit to guide implementation. In this preparation phase we will adapt an existing package of EBPs in consideration of the unique environmental characteristics of PSH and will prepare for implementation. Aim 2 is to evaluate implementation of evidence- based OD prevention practices across diverse PSH buildings and effectiveness on PSH tenant outcomes in a stepped wedge trial. In this Hybrid Type 3 effectiveness-implementation study, the primary implementation outcome is PSH building adoption of the OD prevention EBPs. We will additionally examine secondary implementation outcomes, tenant clinical outcomes, and implementation sustainment. Aim 3 is to explore multilevel factors influencing implementation—including barriers and facilitators—and refine dissemination and implementation frameworks for housing settings, using qualitative interviews with PSH staff. The research draws from the EPIS (Exploration, Preparation, Implementation, Sustainment) implementation framework and Rhodes’ Risk Environment Framework. The research will inform implementation frameworks and strategies by examining application of EPIS for PSH and testing novel housing-relevant implementation strategies including staff-tenant implementation champion dyads. Findings from this PSH-focused research are expected to be more broadly applicable to other types of housing and settings serving people experiencing homelessness. The multidisciplinary investigator team will work with a Stakeholder Advisory Board to maximize impact of the research, which has been designed to inform local and national programmatic and policy interventions. Changes in the epidemiology of the U.S. OD crisis highlight the need for concerted efforts to reduce the disparate burden of ODs faced by particularly marginalized populations.