Supplement to HOME Trial: Role of Justice Involvement in Implementation and Effectiveness of Housing First for Youth Experiencing Homelessness

项目总结 虽然阿片类药物在普通人群中的使用近年来受到了媒体和学术的极大关注， 关于无家可归的年轻人使用阿片类药物的研究很少，尽管有近70%的人 这些年轻人符合非法药物或酒精使用障碍(SUD)的标准，以及吸毒过量和自杀 导致死亡的主要原因。我们的UG3/UH3 Heal Initiative研究是第一个测试“住房优先”(HF) 干预可以减少叶氏患者中阿片类药物的使用。具体而言，正在进行的UH3阶段的“住房，机会-- 青年、动机和参与度“(HOME)研究随机选择了240名18-24岁的阿片类药物高危人群 使用障碍(OUD)到住房+阿片类药物和相关风险预防服务(n=120)，或阿片类药物和相关风险 仅提供预防服务(n=120)。然而，HF的实施在规模上是具有挑战性的，因为司法系统 参与往往会阻止或推迟叶诗文的住房购买。在日益紧张的住房市场中，土地- 涉及刑事司法的住房障碍(CJI)给实施者带来了许多障碍- 心力衰竭(例如，犯罪背景调查，以筛选出有CJI前科的申请者，不愿意申请- 证明申请或出租给有CJI记录的个人)，并推迟了CJI青少年的HF。一致 鉴于NIDA有兴趣支持现有裁决的额外司法措施(非-DA-23-011)，我们 将利用一个独特的机会，增加一项混合方法研究，重点探索CJI在 家庭审判。具体地说，我们将首先从关键利益相关者(土地- 上议院、倡导者和YEA)，以探索与 用CJI实现了YEH的高频。这些新数据将提供初步的见解，包括特定类型的 CJI(例如，事件的数量和类型，包括监禁、缓刑、逮捕令)影响HF的参与 和住房决定，为什么房东做和不租给叶与CJI，以及哪些各种激励措施和 方法(例如，增加押金、租赁券、损害保护)可以克服障碍，实施- 门庭HF与叶，与CJI。接下来，我们将完成对新变量的补充量化分析 与之前的CJI和住房购买延迟时间相关，以测试CJI对主要研究结果的影响。我们的 基于成人心力衰竭计划的先前文献的中心假设是，心力衰竭干预将 对有和没有CJI的YEH有不同的影响，住房延误可能会恶化结果。我们的结果 将有助于更好地了解YEA与CJI实施HF的障碍和促进者，因为 以及CJI对叶氏患者心力衰竭干预结果的影响。我们的结果将产生重大影响 关于减少阿片类药物使用和OUD并防止生命损失，考虑到OUD的负担和阿片类药物的高风险 在这一人群中服药过量以及他们经历更长时间无家可归的风险增加。

PROJECT SUMMARY While opioid use in the general population has received significant media and scholarly attention in recent years, very little research exists on opioid use among youth experiencing homelessness (YEH), despite nearly 70% of these youth meeting criteria for illicit drug or alcohol use disorders (SUD), and drug overdose and suicide being the leading causes of death. Our UG3/UH3 Heal Initiative study is the first to test whether a “housing first” (HF) intervention can reduce opioid use among YEH. Specifically, the ongoing UH3 phase of the “Housing, Opportu- nities, Motivation and Engagement” (HOME) study is randomizing 240 YEH ages 18-24 at high risk for opioid use disorder (OUD) to housing + opioid and related risk prevention services (n=120), or opioid and related risk prevention services alone (n=120). However, HF implementation is challenging on scale because justice system involvement often prevents or delays housing acquisition for YEH. In the increasingly tight housing market, land- lord barriers to housing YEH with criminal justice involvement (CJI) present numerous obstacles to the imple- mentation of HF (e.g., criminal background checks to screen out applicants with prior CJI, unwillingness to ap- prove applications or rent to individuals with a CJI record) and have delayed HF for youth with CJI. Consistent with NIDA's interest in supporting additional justice measures for existing awards (NOT-DA-23-011), we will capitalize on a unique opportunity to add a mixed-methods study focused on exploring the role of CJI in the HOME trial. Specifically, we will first collect new in-depth qualitative interview data from key stakeholders (land- lords, advocates, and YEH) to explore the contextual determinants (i.e., barriers and facilitators) related to the implementation of HF for YEH with CJI. This new data will provide first insights, including how specific types of CJI (e.g., number of incidents and types including incarceration, probation, warrants) influence HF participation and housing decisions, why landlords did and did not rent to YEH with CJI, and what various incentives and methods (e.g., increased deposits, rental vouchers, damage protection) could overcome the barriers to imple- menting HF with YEH with CJI. Next, we will complete supplemental quantitative analyses of new variables related to prior CJI and delayed time to housing acquisition to test the effect of CJI on main study outcomes. Our central hypotheses, based on prior literature among HF programs for adults, are that the HF intervention will have differential effects for YEH with and without CJI and that housing delays may worsen outcomes. Our results will contribute to a better understanding of barriers and facilitators of HF implementation for YEH with CJI, as well as the effects of CJI on outcomes of HF interventions among YEH. Our results will have significant impact on reducing opioid use and OUD and preventing loss of life, given the burden of OUD and high risk for opioid overdose in this population and their heightened risk for experiencing longer periods of homelessness.