Building Social and Structural Connections for the Prevention of OUD among Youth Experiencing Homelessness: An RCT Examining Biopsychosocial Mechanisms

项目摘要/摘要 无家可归严重影响健康和福祉，对青年尤其不利。70%-95%的 经历无家可归的青少年(YH)报告药物使用问题，66%-89%有心理健康 无序。年轻人露宿街头或无家可归的风险似乎比成年人更大，而且 容易受到无家可归的长期后果的影响。健康的多种社会决定因素(SDOH)是 与无家可归、使用驱动力物质和不良心理健康后果有关。 然而，有限的研究确定了对以下方面具有长期改善影响的务实干预措施 这些年轻人中复杂的、多症状的问题。这项研究克服了以往研究中的空白，通过 检测针对可能影响SDOH的多组分综合预防干预 生物、心理和社会健康指标和长期健康结果。与明星之家合作，顺便拜访一下 叶氏中心，年龄在14岁到24岁之间的年轻人，将被订婚并随机分配到条件 使用拆卸设计，以便能够有效地识别必要的干预组件。特别是， 青年(N=300)将被随机分配到a)激励性访谈/社区强化方法 +照常服务(MI/CRA+SAU，n=80)，b)以优势为基础的外联和宣传+SAU(SBOA+ SAU，n=80)，c)MI/CRA+SBOA+SAU(n=80)或d)SAU(n=60)。为了评估 对于物质使用、心理健康和其他结果的长期预防效果，所有青年都将 在基线以及基线后3、6、12、18和24个月进行评估。这项研究的主要目标是 建立嵌入到服务于YEH的系统中的全面干预的影响，社区 青少年阿片类药物滥用和障碍、其他物质滥用和障碍、心理健康 诊断和其他有针对性的结果。这项研究将提供有关潜在变化途径的独特信息 针对特定的青年分组，以及费用估计数，以便为未来在收容中心的实施工作提供信息 在全国各地。

Project Summary/Abstract Homelessness severely affects health and well-being and is particularly negative for youth. Between 70-95% of youth experiencing homelessness (YEH) report problem substance use and 66-89% have a mental health disorder. Youth appear to be at greater risk for living on the streets or being homeless than adults and are more vulnerable to long term consequences of homelessness. Multiple social determinants of health (SDOH) are uniquely associated with homelessness, driving substance use and adverse mental health consequences. However, limited research has identified pragmatic interventions that have a long-term ameliorating impact on the complex, multi-symptomatic issues among these youth. This study overcomes prior gaps in research through testing a multi-component comprehensive prevention intervention targeting SDOH that may affect biopsychosocial health indicators and longer-term health outcomes. In partnership with Star House, a drop-in center for YEH, youth between the ages of 14 to 24 years, will be engaged and randomly assigned to conditions using a dismantling design so that essential intervention components can be efficiently identified. In particular, youth (N = 300) will be randomly assigned to a) Motivational Interviewing/Community Reinforcement Approach + Services as Usual (MI/CRA + SAU, n = 80), b) Strengths-Based Outreach and Advocacy + SAU (SBOA + SAU, n = 80), c) MI/CRA + SBOA + SAU (n = 80) or d) SAU (n=60) through the drop-in center. In order to assess the longer-term prevention effects on substance use, mental health and other outcomes, all youth will be assessed at baseline and at 3, 6, 12, 18 and 24-months post-baseline. The primary goal of this study is to establish the impact of a comprehensive intervention embedded within a system that serves YEH, a community drop-in center, on youth’s opioid misuse and disorder, other substance misuse and disorders, mental health diagnoses, and other targeted outcomes. This study will offer unique information on pathways underlying change for specific subgroups of youth along with cost estimates to inform future implementation efforts in drop-in centers around the country.