Evaluation of Kentucky Access to Recovery Linkage Strategy

美国疾病控制与预防中心国家卫生统计中心(NCHS)估计，在截至 2021年9月在美国，有99,543人死于药物过量。肯塔基州获得第二名 2020年，美国经年龄调整的药物过量死亡率最高(每10万人中有51.5人死亡)。至 应对吸毒过量死亡人数居高不下的问题，需要采取有效的策略将南德地区的人联系起来 治疗或那些尚未接受康复支持服务(RSS)治疗的非法SUD患者 维持恢复，减少非法药物使用和药物过量的重新出现。获得恢复权限 (ATR)是一种由药物滥用和精神卫生服务管理局支持的联动策略 (SAMHSA)，由肯塔基州于2019年实施，将弱势群体与阿片类药物和/或 使用凭单系统将刺激剂SUD到RSS，并在恢复后将客户重新链接到RSS 物质使用。肯塔基州ATR(Katr)战略是一个25个县的计划，将县居民连接到或 低于200%的国家贫困水平，他们拥有非法肥皂，正在接受治疗或早期康复，以 以证据为基础的社会保障体系，如恢复住房和其他社会保障体系。由Katr设置的优先级Katr客户端为 涉及正义的、退伍军人、怀孕/产后和育儿人群。要解决以下问题 对于脆弱人群中经常出现的RSS的可及性，Katr联动方法使用 代金券作为SUD治疗中没有其他资金选择的个人的一种联系策略 获取关键RSS。因此，Katr通过凭证进行链接是链接到 RSS。这项建议的目的是对最后一项工作进行严格的过程和结果评估 通过实现以下具体目标实现联系度假村代金券的战略：具体目标1：开展 对Katr联动战略进行过程评估，以确定Katr战略是否可接受以及 与RSS有关联的持有非法SUD的弱势人群可以接触到；确定障碍和促进者 对《卡特里娜行动纲领》的执行情况进行评估；并评估《卡特里娜飓风行动纲领》战略按设计执行的程度。 具体目标2：对卡特里娜飓风联动战略进行成果和影响评估。具体目标3： 评估在人群中实施代金券作为联系策略的长期有效性 在没有其他资金来源的情况下需要RSS。受试者内部设计将被用来测试 卡特尔代金券联动方法在降低非致命性和致命性过量用药风险方面的有效性 通过增加个人的回收资金；减少重新开始使用非法药物；以及促进 如果恢复非法药物使用，则重新链接到RSS。研究结果可能会增强当前状态的ATR 为经历类似SUD健康获取差距的个人提供服务。

The CDC National Center for Health Statistics (NCHS) estimates that for the 12-month period ending September 2021 in the United States, (US) there were 99,543 drug overdose deaths. Kentucky had the 2nd highest age-adjusted drug overdose fatality rate (51.5 deaths/100,000 persons) in the US in 2020. To address the high numbers of drug overdose fatalities, effective strategies are needed to link persons in SUD treatment or those with illicit SUD not yet in treatment with recovery support services (RSSs) to build and maintain recovery, and reduce resumption of illicit substance use and drug overdoses. Access to Recovery (ATR) is a linkage strategy supported by Substance Abuse and Mental Health Services Administration (SAMHSA) that was implemented by Kentucky in 2019 to link vulnerable populations with opioid and/or stimulant SUDs to RSSs using a voucher system and re-link clients to RSSs following resumption of substance use. The Kentucky ATR (KATR) strategy is a 25-county program that links county residents at or below the 200% national poverty level who have illicit SUDs and are in treatment or early recovery to evidence-based RSSs such as recovery housing, and to other RSSs. Priority KATR clients set by KATR are justice-involved, veteran, pregnant/ postpartum, and parenting populations. To address the gap in accessibility of RSSs that often occurs in vulnerable populations, the KATR linkage approach uses vouchers as a linkage strategy for individuals in SUD treatment who have no other funding options to acquire critical RSSs. As such, KATR’s linkage through vouchers is a “last resort” approach for linking to RSSs. The purpose of this proposal is to perform a rigorous process and outcome evaluation of this last resort voucher strategy of linking by accomplishing the following specific aims: Specific Aim 1: Conduct a process evaluation of the KATR linkage strategy to determine whether the KATR strategy is acceptable and accessible to vulnerable populations with illicit SUD who are linked to RSSs; identify barriers and facilitators to KATR implementation; and assess the extent to which the KATR strategy was implemented as designed. Specific Aim 2: Conduct an outcome and impact evaluation of the KATR linkage strategy. Specific Aim 3: Evaluate the long-term effectiveness of implementing vouchers as a linkage strategy in a population requiring RSSs when no other funding sources are available. A within-subjects design will be used to test the effectiveness of the KATR voucher linkage approach to reducing the risk of nonfatal and fatal overdoses by increasing an individual’s recovery capital; reducing resumption of illicit substance use; and promoting relinking to RSSs if illicit substance use is resumed. Study results may enhance current state ATRs that serve individuals experiencing similar SUD health access disparities.