Using SMART Design to Identify an Effective and Cost-Beneficial Approach to Preventing OUD in Justice-Involved Youth

使用 SMART 设计确定有效且具有成本效益的方法，以防止参与司法的青少年出现 OUD

基本信息

批准号：
10441666
负责人：
KYM R AHRENS
金额：
$ 337.04万
依托单位：
SEATTLE CHILDREN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-30 至 2024-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10441666
关键词：
Address Adolescent Adolescent and Young Adult Assertiveness Award Back Biometry Caring Clinical Trials Collaborations Communities Cost Analysis Cost Savings Cost-Benefit Analysis Costs and Benefits Country Criminal Justice Custom Data Data Collection Data Reporting Economics Effectiveness Ensure Epidemic Evidence based intervention Frequencies Future Grant Health Infrastructure Institution Interruption Intervention Justice Measures Methods Modeling Opioid Outcome Overdose Participant Patient Self-Report Pediatric Hospitals Phase Population Prevention Prevention strategy Procedures Protocols documentation Psychological reinforcement Recording of previous events Rehabilitation therapy Research Personnel Resources Rewards Risk Risk Factors Sampling Self Administration Sequential Multiple Assignment Randomized Trial Substance Use Disorder Surveys System Trauma Universities University Hospitals Urine Washington Youth adaptive intervention aged base contingency management cost cost effective cost effectiveness cost outcomes disorder prevention effective intervention effectiveness evaluation experimental study high risk improved innovation motivational enhancement therapy non-opioid analgesic opioid use opioid use disorder prevent preventive intervention primary outcome programs recidivism recruit reduced substance use retention rate secondary outcome social substance use substance use prevention treatment as usual trial design

项目摘要

PROJECT SUMMARY Non-prescription opiate use in adolescents and young adults is epidemic in our country and overdose-related fatalities are rising. Adolescents and young adults in justice settings (AYAJS) have some of the highest rates of opioid use disorder (OUD), with national rates approaching 20%. The majority of AYAJS engage in problematic non-opioid substance use, which is a critical risk factor for OUD. Non-opioid substance use disorders (SUDs) and OUD, in turn, are two of the most important predictors of subsequent re-involvement in juvenile or criminal justice systems. Seattle Children’s Hospital (SCH), University of Washington (UW), and Washington State Juvenile Rehabilitation (WSJR) will collaboratively evaluate OUD prevention interventions of varying intensities based on the Adolescent Community Reinforcement Approach with Assertive Continuing Care (ACRA/ACC). Multiple studies have established effectiveness of ACRA/ACC in reducing SUD; however none have evaluated it as an OUD prevention strategy. SUD is incredibly common and costly among AYAJS; thus ACRA/ACC- based approaches are likely to be effective and cost-beneficial OUD prevention strategies for this group. However, we need to determine the optimal intensity of an ACRA/ACC-based OUD prevention intervention for AYAJS with and without non-opioid SUD, as these groups are likely to have differing prevention needs. We will use Sequential Multiple Assignment Randomized Trial (SMART) to construct high-quality adaptive interventions (AIs) containing ACRA/ACC-based OUD prevention strategies of different intensity levels among SUD and non-SUD youth. In our 2-year UG3 phase, we will collaboratively plan for a SMART experiment, i.e.: finalize infrastructure, recruitment, intervention, and data collection procedures; and create infrastructure for sustainable future implementation of effective interventions after the UH3 full trial (UG3 Aim 1). We will conduct a pilot with 40 AYAJS to assess feasibility of protocols and procedures, recruitment, engagement, and retention strategies in anticipation of full trial (UG3 Aim 2). In our 3-year UH3 phase, we will conduct a SMART trial with 430 AYAJS aged 16-25 from all WSJR institutions to evaluate ACRA/ACC-based OUD prevention interventions of various intensity levels among SUD and non-SUD youth (UH3 Aim 1). We will administer self- report electronic surveys at baseline, 1, 3 & 6 months to collect cost and outcomes data on primary outcomes (initiation and escalation of use measured by number of days and frequency of use of any substances) and secondary outcomes (number of days/frequency of use of specific substances including opioids, others); we will use administrative data to measure recidivism. Our UH3 Aim 2 will be to conduct comprehensive cost analyses to estimate the resources required to implement our ACRA-based interventions. Our proposal is responsive to the RFA, innovative in its degree of partnership with WSJR as well as in its rigorous and pragmatic SMART design. It is also high impact in that it is highly likely to prevent OUD for one of the most vulnerable youth populations in our country.

项目概要青少年和年轻人使用非处方阿片类药物在我国很流行，且与药物过量有关司法环境中的青少年和年轻人（AYAJS）的死亡率正在上升。阿片类药物使用障碍 (OUD)，全国比例接近 20% 大多数 AYAJS 都有问题。非阿片类物质使用，这是 OUD 的关键危险因素。反过来，OUD 是随后再次卷入青少年或犯罪行为的两个最重要的预测因素。西雅图儿童医院 (SCH)、华盛顿大学 (UW) 和华盛顿州司法系统。青少年康复中心 (WSJR) 将合作评估不同强度的 OUD 预防干预措施基于积极持续护理的青少年社区强化方法 (ACRA/ACC)。多项研究已证实 ACRA/ACC 在减少 SUD 方面的有效性，但尚未进行评估；它作为 OUD 预防策略在 AYAJS 中非常普遍且成本高昂；因此 ACRA/ACC- 对于这一群体来说，基于方法的 OUD 预防策略可能是有效且具有成本效益的。然而，我们需要确定基于 ACRA/ACC 的 OUD 预防干预的最佳强度含有或不含非阿片类 SUD 的 AYAJS，因为这些群体可能有不同的预防需求。使用序贯多重分配随机试验（SMART）构建高质量的自适应干预措施 (AI)，包含基于 ACRA/ACC 的不同强度级别的 OUD 预防策略 SUD 和非 SUD 青少年在为期 2 年的 UG3 阶段，我们将合作规划 SMART 实验，即：最终确定基础设施、招募、干预和数据收集程序；并创建基础设施； UH3 全面试验（UG3 目标 1）后，我们将在未来实施可持续的有效干预措施。与 40 名 AYAJS 进行试点，以评估方案和程序、招募、参与和实施的可行性预期全面试验的保留策略（UG3 目标 2）在我们为期 3 年的 UH3 阶段，我们将进行 SMART。来自所有 WSJR 机构的 430 名 16-25 岁 AYAJS 进行试验，以评估基于 ACRA/ACC 的 OUD 预防对 SUD 和非 SUD 青年进行不同强度的干预（UH3 目标 1）。报告基线、1、3 和 6 个月的电子调查，以收集主要结果的成本和结果数据（使用任何物质的开始和升级以天数和使用频率来衡量）和次要结果（使用特定物质（包括阿片类药物等）的天数/频率；我们的 UH3 目标 2 将使用行政数据来衡量累犯率。分析以估计实施基于 ACRA 的干预措施所需的资源。我们的建议是。响应自由亚洲电台 (RFA)，与 WSJR 的合作程度以及严格和严谨的态度具有创新性务实的 SMART 设计也具有很高的影响力，因为它很可能阻止 OUD 成为最重要的设计之一。我国的弱势青年群体。