Implementation of Overdose Prevention Practices in Permanent Supportive Housing

项目摘要 永久支持性住房（PSH）是结束长期无家可归的黄金标准干预措施， 近年来在美国迅速扩大，并可能继续扩大无家可归者。 于COVID-19疫情爆发后，本集团之营业额增加。由于个人和环境风险的汇合， 考虑到这些因素，PSH租户面临过量（OD）的风险增加。虽然循证实践（EBP）， 尽管存在预防OD的措施，但它们尚未在PSH环境中广泛实施。我们建议解决这个问题 通过为PSH定制一套基于证据的OD预防实践， 设置，然后研究他们在纽约的20个PSH建筑物的实施。我们将测试一组 实施战略，包括实施工具包，租户-工作人员实施冠军二人组， 有限的实践促进和学习协作。该项目将与 支持性住房公司，一个全国性组织，通过以下方式推进改善PSH的解决方案 教育、实践和政策。目的1是采用循证OD预防措施， 我们还将与利益攸关方重点小组合作，并制定一个预防儿童和青少年吸毒工具包，以指导实施工作。在这 在准备阶段，我们将考虑到独特的环境因素， PSH的特点，并准备实施。目的二是评估证据的执行情况- 基于不同PSH建筑物的OD预防实践以及PSH租户结果的有效性， 阶梯楔形试验在这项混合型3有效性-实施研究中，主要实施 结果是PSH大楼采用了预防OD的EBP。我们还将检查中学 实施结果、租户临床结果和实施支持。目标3：探索 影响执行的多层次因素-包括障碍和促进因素-并改进传播和 执行框架的住房设置，使用定性访谈PSH工作人员。研究 借鉴EPIS（勘探、准备、实施、维持）实施框架， 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： 研究公共房屋署公共房屋资讯系统的应用情况，并测试与房屋有关的新推行策略，包括 工作人员-租户实施冠军组合。这项以PSH为重点的研究的结果预计将 更广泛地适用于为无家可归者服务的其他类型的住房和环境。 多学科调查员小组将与利益攸关方咨询委员会合作，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出表明，需要共同努力， 特别是边缘化人群面临的不同的口服药物负担。

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.