Knock and Talk: Public Health-Public Safety Partnerships for Post-Overdose Outreach and Prevention

项目摘要/摘要：非致命性阿片类药物过量是随后致命的最强预测因素 服药过量。因此，非致命的过量用药提供了一个关键的机会，让幸存者参与到减少伤害中来。 和/或治疗服务，以减少未来致命过量的可能性。《敲门问答》节目是 新出现的二级预防干预措施，旨在降低幸存者未来服药过量的风险。 尽管它们差异很大，但这些计划有三个共同特点：1)在 急救人员(消防、警察和/或紧急医疗服务)和公共卫生方案(减少危害、 成瘾治疗和/或精神健康提供者)；2)在非致命性的 服药过量；3)将幸存者与治疗和服药过量预防服务联系起来。自2015年以来，敲门和 Talk(KT)项目已经扩展到60多个马萨诸塞州市政当局。KT程序可以 通过最大限度地减少阿片类药物使用者的耻辱，减少过量用药，促进更好的结果 危险行为，增加纳洛酮抢救的可能性，并激励幸存者进入护理。 KT计划在马萨诸塞州的一些市政当局的出现，但在其他市政当局，提供了一个 史无前例的机会进行自然实验来评估这些措施的有效性 干预措施。此外，有机会确定最佳做法、意外后果、 实施障碍和促进者，并制定循证指南建议 这些节目。因此，这项建议的具体目标是：1)完成全面清查， 包括马萨诸塞州KT项目的主要特征，使用全州范围的当地公共安全调查和 公共卫生机构；2)确定最佳做法、意外后果和实施障碍 和促进者使用KT遭遇的直接观察和对一线工作人员的定性采访，以及 在20个有代表性的KT项目中抽样调查KT服务的接受者；3)确定KT服务的有效性 KT方案通过比较a)有和没有KT方案的市政当局和 B)在KT方案中具有和不具有选定关键特征的市政当局，使用中断时间- 系列分析；以及4)制定对公共卫生和公众有用的KT计划指南建议 安全机构，基于AIMS 1-3的发现和文献回顾，使用改进的Delphi过程 拥有一个由公共卫生和公共安全专家组成的杰出小组。 为了完成提出的混合方法研究，我们组装了一个高质量的和 在发展和实施这些伙伴关系方面具有专业知识的成熟的多学科团队，准 实验因果推理方法、定量调查和形成性定性方法以及公众 卫生法律、政策和道德。我们将制定切实可行的、有证据的指南建议， 实施和维持KT计划的公共卫生和公共安全机构。

Project Summary/Abstract: Non-fatal opioid overdose is the strongest predictor of a subsequent fatal overdose. Thus, a non-fatal overdose offers a pivotal opportunity to engage the survivor in harm reduction and/or treatment services to reduce the likelihood of a future fatal overdose. “Knock and Talk” programs are emerging secondary prevention interventions designed to reduce the risk of a future overdose in survivors. Although they differ widely, these programs share three common characteristics: 1) a collaboration between first responders (fire, police and/or emergency medical services) and public health programs (harm reduction, addiction treatment and/or mental health providers); 2) community-based outreach following a nonfatal overdose; and 3) linking of survivors to treatment and overdose prevention services. Since 2015, Knock and Talk (KT) programs have proliferated to more than 60 Massachusetts municipalities. KT programs can promote better outcomes by minimizing the stigma experienced by people who use opioids, reducing overdose risk behaviors, increasing the likelihood of a naloxone rescue, and motivating survivors to enter care. The emergence of KT programs in some Massachusetts municipalities, but not others, affords an unprecedented opportunity to conduct a natural experiment to evaluate the effectiveness of these interventions. Further, the opportunity exists to identify best practices, unintended consequences, implementation barriers and facilitators, and to develop evidence-informed guideline recommendations for these programs. Thus, the specific aims of this proposal are: 1) To complete a comprehensive inventory, including key characteristics, of Massachusetts KT programs using a statewide survey of local public safety and public health agencies; 2) To identify best practices, unintended consequences, and implementation barriers and facilitators using direct observation of KT encounters and qualitative interviews with front line staff and recipients of KT services in a subsample of 20 representative KT programs; 3) To determine the effectiveness of KT programs in reducing opioid overdoses by comparing a) municipalities with and without KT programs and b) municipalities with and without selected key characteristics among KT programs, using interrupted time- series analyses; and 4) To develop KT program guideline recommendations useful to public health and public safety agencies, based on findings from Aims 1-3 and a review of the literature, using a modified Delphi process with a distinguished panel of public health and public safety experts. To accomplish the proposed mixed methods research, we have assembled a highly qualified and accomplished multidisciplinary team with expertise in developing and implementing these partnerships, quasi- experimental causal inference approaches, quantitative survey and formative qualitative methods, and public health law, policy and ethics. We will develop practical and evidence-informed guideline recommendations for public health and public safety agencies implementing and sustaining KT programs.