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: 10621857
• 负责人: Matthew Aalsma
• 金额: $ 90.9万
• 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 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10621857
• 关键词: Address; Adolescent; Affect; Biological Models; Caring; 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; Outcome Assessment; Overdose; Pharmaceutical Preparations; Policies; Population; Prevention; Public Health; Randomized; 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; 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; randomized, clinical trials; 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