INDIVIDUAL PLACEMENT AND SUPPORT FOR VETERANS WITH OPIOID USE DISORDER: A MIXED METHODS STUDY

对患有阿片类药物使用障碍的退伍军人的单独安置和支持：混合方法研究

基本信息

批准号：
10701819
负责人：
LORI L. DAVIS
金额：
--
依托单位：
TUSCALOOSA VETERANS AFFAIRS MEDICAL CTR
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-10-01 至 2026-09-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10701819
关键词：
Abstinence Address Adherence Anxiety Area Back COVID-19 COVID-19 impact COVID-19 pandemic COVID-19 pandemic effects Communities Consensus Control Groups Data Deterioration Diagnosis Economic Burden Economics Effectiveness Employment Environment Evaluation Feeling hopeless General Population Goals Homelessness Income Individual Interruption Intervention Interview Link Measures Mental Depression Mental Health Mental disorders Methods Modeling Modification Occupational Occupations Outcome Participant Patient Self-Report Persons Pilot Projects Population Post-Traumatic Stress Disorders Poverty Prevention Process Productivity Provider Psyche structure Public Health Publishing Quality of life Randomized Randomized, Controlled Trials Recovery Rehabilitation therapy Relapse Reporting Research Research Personnel Research Support Resources Sample Size Sampling Self Efficacy Services Site Social Distance Social isolation Socialization Specialist Structure Substance Use Disorder Supported Employment Symptoms Treatment outcome Unemployment Veterans Vocation Vocational rehabilitation Waiting Lists Work arm community based participatory research community engagement design effectiveness evaluation efficacy evaluation efficacy testing evidence base experience follow-up functional independence implementation evaluation implementation facilitators improved interest medication for opioid use disorder methadone treatment opioid epidemic opioid use disorder patient population perceived stress primary care setting prospective rehabilitation service relapse prevention research and development resilience rural area substance use success suicidal risk systematic review treatment adherence treatment as usual

项目摘要

Background: Living with an opioid use disorder (OUD) can make finding and sustaining employment a significant challenge and is only getting worse in the COVID-19 environment. With states reporting unemployment rates as high as 15-20%, the negative effects of unemployment on OUD treatment outcomes are expected to deteriorate. The COVID-19 pandemic has further resulted in treatment disruptions that are exacerbating poor outcomes, because of unemployment, social isolation, interrupted access to medication for OUD treatment (MOUD), and interference of daily routines that provide the necessary structure for many people with OUD. Our group has conducted research that shows Individual Placement and Support (IPS) is efficacious in yielding more weeks worked and higher steady employment rates for Veterans with posttraumatic stress disorder and Veterans diagnosed with a broad range of mental conditions (including substance use) being treated in a primary care setting; however, little is known about its efficacy in Veterans with OUD. Only one small study in civilians (n=45) with OUD has been conducted, in which 50% of the participants assigned to IPS gained employment compared to 5% of waitlist control at 6 months follow-up (p<0.001). A systematic review of effectiveness of IPS with conditions other than serious psychiatric mental illness revealed major limitations in many studies, including small sample sizes, major modifications to IPS model, weak control, and short follow-up periods. A larger randomized controlled trial of IPS for Veterans recovering from OUD with longer follow-up period, strong treatment control, and strict adherence to IPS fidelity, such as the one we propose, is warranted. Methods: This is a prospective, multi-site, randomized controlled trial to determine the efficacy of IPS compared to non-IPS Treatment-as-Usual Vocational Rehabilitation (TAU-VR) in a sample of 120 Veterans recovering from OUD (Aim 1). Investigators hypothesize that Veterans with OUD randomized to IPS will work significantly more weeks in a competitive job over 15 months compared to the non-IPS TAU-VR group. Additionally, compared to non-IPS TAU-VR, IPS recipients will earn significantly more income from competitive jobs and be significantly more likely to achieve steady employment. The investigators will also evaluate self-report measures of resilience, quality of life, perceived stress, community engagement, depression, anxiety, abstinence self-efficacy and suicide risk. As Aim 2, using a Community Based Participatory Research (CBRP) approach, the investigators will identify the contextual barriers to and facilitators of implementing vocational services for Veterans in both the IPS and non-IPS TAU-VR study arms, including evaluation of employment challenges, optimal occupational functioning, and OUD treatment adherence, with specific emphasis on the impact of COVID-19 and social distancing. To address Aim 2, the investigators will conduct semi-structured interviews with Veterans with OUD randomized to IPS or non-IPS TAU-VR. These interviews will be supplemented by qualitative findings from an ongoing Rehabilitation R&D pilot study that includes qualitative interviews on the same topic with IPS specialists, providers, unemployed veterans with OUD, and potential employers. Working with a CBPR Steering Committee, findings will be aggregated to reach consensus on best practices for IPS implementation in this new population. In an Exploratory Aim 3, the impact of IPS will be compared to non-IPS TAU-VR on participants’ adherence to MOUD and rates of OUD relapse. Significance: This study seeks to find the best intervention for successful recovery and functional reintegration for Veterans recovering from OUD. This study is especially timely given the societal impact of the COVID-19 pandemic on employment and mental health problems of the general population, and Veterans specifically. Additionally, with the new VHA plan to expand supported employment services to Veterans with substance use disorders in the coming years, our study is timely and can significantly contribute to the evidence required to successfully implement and sustain supported employment services in this new priority population.

背景：患有阿片类药物使用障碍（OUD）的生活可以使发现和维持就业巨大的挑战，只有在19日环境中变得更糟。与国家报告失业率高达15-20％，失业对OUD治疗结果的负面影响是预计将检测到。 COVID-19大流行进一步导致治疗中断由于失业，社会隔离，无法获得药物的访问，加剧了不良的结果 Oud处理（MOUD），以及对许多人提供必要结构的日常工作的干扰与Oud。我们的小组进行了研究，显示个人安置和支持（IP）是有效的在产生越来越多的几周和较高的稳定就业率中，具有创伤后压力的退伍军人疾病和退伍军人被诊断出患有广泛的心理状况（包括使用物质）在初级保健环境中进行治疗；但是，对其在Oud的退伍军人中的效率知之甚少。只有一个小已经进行了对OUD的平民研究（n = 45），其中有50％的参与者分配给IPS 工作时间为6个月的随访（P <0.001），而候补名单对照的雇用为5％。系统评价 IPS与严重精神疾病以外的其他条件的有效性揭示了主要局限性许多研究，包括小样本量，对IPS模型的重大修改，弱对照和短随访时期。 IPS的更大的随机对照试验，用于从OUD中恢复的退伍军人，随访较长有必要进行时期，强大的治疗控制和严格遵守IPS保真度，例如我们提出的一个。方法：这是一项前瞻性，多站点，随机对照试验，可确定IPS的效率在120名退伍军人中，从 OUD（AIM 1）。调查人员假设将随机分配给IPS的退伍军人将更多地工作与非tau-vr组相比，在15个月内的竞争工作数周。另外，与非支柱tau-vr，IPS收件人将从竞争性工作中获得更多收入，并且收入更多更有可能实现稳定的就业。调查人员还将评估自我报告的弹性测度，生活质量，感知压力，社区参与，抑郁，动画，戒酒自我效能和自杀风险。作为目标2，研究人员使用基于社区的参与研究（CBRP）方法将确定在这两个中为退伍军人实施选民服务的上下文障碍和促进者 IPS和非支柱TAU-VR研究组，包括评估就业挑战，最佳占领功能和OUD治疗依从性，特别强调Covid-19和社会的影响远处。为了解决AIM 2，调查人员将对Oud进行半结构化访谈随机分配给IPS或非tau-vr。这些访谈将由一个定性调查结果补充正在进行的康复研发试点研究，其中包括与IPS专家对同一主题的定性访谈，提供者，拥有OUD的失业退伍军人以及潜在的员工。与CBPR指导委员会合作，调查结果将被汇总，以在该新人群中对IPS实施的最佳实践达成共识。在探索性目标3中，IPS的影响将与非支柱Tau-VR的影响对参与者遵守穆德退休率。意义：本研究旨在为成功恢复和功能重新整合找到最佳干预措施对于从Oud恢复的退伍军人。鉴于Covid-19的社会影响，这项研究尤其及时专门针对普通人群的就业和心理健康问题的大流行。此外，随着新的VHA计划将支持的就业服务扩展到退伍军人，并在未来几年的疾病中，我们的研究是及时的，可以为在这个新的优先人群中，成功实施并维持了支持的员工服务。