Transitions Clinic Network: Post Incarceration Addiction Treatment, Healthcare, and Social Support (TCN PATHS) study

项目摘要 阿片类药物的流行与我们国家的刑事司法系统密不可分。至少有20%的人 阿片类药物使用障碍（OUD）在2016年被卷入刑事司法系统， 出狱后吸毒过量的风险是普通人群的八倍 根据年龄、性别、种族和居住区进行调整。考虑到这种风险，一些监狱现在将OUD 但是，如果这些努力未能将人们与OUD治疗联系起来， release.住房不稳定，粮食不安全，缺乏社会支持，对卫生系统的不信任， 身体和精神健康状况威胁到一个人参与和留在社区OUD的能力 治疗以前的工作还没有确定有效的战略，使正义参与个人在OUD护理 这些方法是可行的，并且荣誉患者的价值观、偏好和需求。在解决这一知识差距之前， 将难以降低美国阿片类药物相关的发病率和死亡率。我们的长期目标是 降低涉及司法的个人中OUD的发病率和死亡率。本研究的总体目标 是评估提供增强型初级保健的过渡诊所网络（TCN）计划 和OUD治疗最近从监禁中释放的人，改善了阿片类药物治疗的措施， 级联。在TCN，以前被监禁的社区卫生工作者被嵌入初级保健团队 解决OUD的社会决定因素，提供社会支持，帮助患者建立对卫生系统的信任， 并倡导与刑事司法系统的互动。Transitions Clinic的核心假设 网络：监禁后成瘾治疗，医疗保健和社会支持（TCN PATHS）研究是， TCN计划的参与改善了刚从监狱释放的人的阿片类药物治疗级联措施 治疗OUD的药物这项研究的基本原理是，必须满足社会需求， 通过社区卫生工作者，支持OUD治疗参与和初级保健之家 为人们对OUD治疗的优先级、需求和偏好的转变提供了一个灵活的结构， release.我们将进行一项混合I型有效性实施试验，随机抽取800人， 从6个地方监狱（明尼苏达州明尼阿波利斯，纽约州罗切斯特，康涅狄格州布里奇波特，达勒姆， NC，Caguas，PR和布朗克斯，NY）比较TCN干预与转诊的有效性， 标准初级保健对阿片类药物治疗级联结果的影响，以及住房、食物获取、刑事 司法联系、社会支持在此中介作用。我们亦会研究 TCN，以及将OUD患者的护理过渡到TCN的障碍和促进因素。TCN路径 在与前被监禁者的伙伴关系和优先重视其价值观方面具有高度创新性。 总之，本提案产生的知识将通过评估有效性产生积极影响， 一个新的初级保健为基础的方法，以改善健康的司法参与个人与OUD。

PROJECT SUMMARY The opioid epidemic is inextricably intertwined with our nation’s criminal justice system. At least 20% of people with opioid use disorder (OUD) were involved in the criminal justice system in 2016, and individuals just released from jail have an eight times higher risk of drug overdose compared with the general population after adjustment for age, gender, race, and residential neighborhood. Given this risk, several jails now treat OUD with medications, but these efforts will be ineffective if they fail to connect people to OUD treatment upon release. Housing instability, food insecurity, lack of social support, mistrust in the health system, and co-morbid physical and mental health conditions threaten a person’s ability to engage and remain in community OUD treatment. Prior work has not identified effective strategies to engage justice-involved individuals in OUD care that are feasible and honor patients’ values, preferences, and needs. Until this knowledge gap addressed, it will be difficult to reduce opioid-related morbidity and mortality in the United States. Our long-term goal is to reduce morbidity and mortality from OUD among justice-involved individuals. The overall objective of this study is to assess whether the Transitions Clinic Network (TCN) program, which provides enhanced primary care and OUD treatment for people recently released from incarceration, improves measures in the opioid treatment cascade. In TCN, formerly incarcerated community health workers are embedded within primary care teams and address social determinants of OUD, provide social support, help patients build trust in the health system and advocate in interactions with the criminal justice system. The central hypothesis of Transitions Clinic Network: Post Incarceration Addiction Treatment, Healthcare, and Social Support (TCN PATHS) study is that TCN program participation improves opioid treatment cascade measures among those just released from jails on medications for OUD. The underlying rationale for this study is that social needs must be addressed, in this case through a community health worker, to support OUD treatment engagement, and a primary care home provides an agile structure for people’s shifting priorities, needs, and preferences for OUD treatment following release. We will conduct a hybrid type I effectiveness-implementation trial and randomize 800 people on medications for OUD released from 6 local jails (Minneapolis, MN, Rochester, NY, Bridgeport, CT, Durham, NC, Caguas, PR, and Bronx, NY) to compare the effectiveness of the TCN intervention versus referral to standard primary care on opioid treatment cascade outcomes and whether housing, food access, criminal justice contact, and social support mediate this association. We will also study the cost effectiveness of the TCN, as well as barriers and facilitators to transitioning the care of people with OUD to the TCN. TCN PATHS is highly innovative in its partnership with and prioritization of the values of formerly incarcerated people. Together, the knowledge produced by this proposal will have a positive impact by evaluating the effectiveness of a new primary care-based approach to improving the health of justice-involved individuals with OUD.