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

建立社会和结构联系以预防无家可归青年中的 OUD：一项检验生物心理社会机制的随机对照试验

• 批准号: 10775030
• 负责人: Jodi Ford
• 金额: $ 144.62万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10775030
• 关键词: Accident and Emergency department; Address; Adolescence; Adult; Advocacy; Advocate; Affect; Age; Automobile Driving; Biological; Child Abuse; Child Abuse and Neglect; Communities; Complex; Cost Effectiveness Analysis; Country; Diagnosis; Discrimination; Disease; Drops; Drug usage; Education; Effectiveness of Interventions; Emotional; Employment; Ethnic Origin; Exposure to; Face; Forcible intercourse; Goals; Health; Health Services Accessibility; Home; Homelessness; Hormones; Hospitals; Housing; Hydrocortisone; Income; Individual; Inflammation; Inflammatory; Intervention; Mediation; Mental Depression; Mental Health; Mental disorders; Motivation; Opioid; Outcome; Overdose; Pain; Pathway interactions; Personal Satisfaction; Persons; Pharmaceutical Preparations; Population; Prevention; Process; Psychological reinforcement; Public Health; Race; Randomized; Recording of previous events; Reporting; Research; Risk; Safety; Self Efficacy; Sexual and Gender Minorities; Social Environment; Social Work; Social isolation; Social support; Stress; Subgroup; Substance Use Disorder; System; Testing; Trauma; Victimization; Youth; adverse childhood events; aged; assault; biopsychosocial; biopsychosocial factor; child neglect; comorbidity; comparison intervention; coping; cost; cost effectiveness; cost estimate; design; disorder prevention; experience; food security; future implementation; help-seeking behavior; human capital; hypothalamic-pituitary-adrenal axis; implementation efforts; improved; innovation; marginalization; motivational enhancement therapy; multiple drug use; opioid epidemic; opioid misuse; opioid use; opioid use disorder; outreach; pragmatic intervention; prevent; preventive intervention; psychosocial resources; resilience; response; service intervention; services as usual; sex; skills; social; social health determinants; societal costs; sociodemographics; substance misuse; substance use; substance use prevention; suicidal behavior; suicidal morbidity; Accident and Emergency department; Address; Adolescence; Adult; Advocacy; Advocate; Affect; Age; Automobile Driving; Biological; Child Abuse; Child Abuse and Neglect; Communities; Complex; Cost Effectiveness Analysis; Country; Diagnosis; Discrimination; Disease; Drops; Drug usage; Education; Effectiveness of Interventions; Emotional; Employment; Ethnic Origin; Exposure to; Face; Forcible intercourse; Goals; Health; Health Services Accessibility; Home; Homelessness; Hormones; Hospitals; Housing; Hydrocortisone; Income; Individual; Inflammation; Inflammatory; Intervention; Mediation; Mental Depression; Mental Health; Mental disorders; Motivation; Opioid; Outcome; Overdose; Pain; Pathway interactions; Personal Satisfaction; Persons; Pharmaceutical Preparations; Population; Prevention; Process; Psychological reinforcement; Public Health; Race; Randomized; Recording of previous events; Reporting; Research; Risk; Safety; Self Efficacy; Sexual and Gender Minorities; Social Environment; Social Work; Social isolation; Social support; Stress; Subgroup; Substance Use Disorder; System; Testing; Trauma; Victimization; Youth; adverse childhood events; aged; assault; biopsychosocial; biopsychosocial factor; child neglect; comorbidity; comparison intervention; coping; cost; cost effectiveness; cost estimate; design; disorder prevention; experience; food security; future implementation; help-seeking behavior; human capital; hypothalamic-pituitary-adrenal axis; implementation efforts; improved; innovation; marginalization; motivational enhancement therapy; multiple drug use; opioid epidemic; opioid misuse; opioid use; opioid use disorder; outreach; pragmatic intervention; prevent; preventive intervention; psychosocial resources; resilience; response; service intervention; services as usual; sex; skills; social; social health determinants; societal costs; sociodemographics; substance misuse; substance use; substance use prevention; suicidal behavior; suicidal morbidity

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.

项目摘要/摘要 无家可归会严重影响健康和福祉，对青年人尤为负面。在70-95％之间 经历无家可归者（YEH）的青年报告使用问题和66-89％的人心理健康 紊乱。年轻人似乎比成年人更容易出现在街上或无家可归的风险，而且更多 容易受到无家可归的长期后果的影响。健康的多个社会决定者（SDOH）是 与无家可归，驱动药物使用和心理健康后果的独特相关。 但是，有限的研究确定了对长期改善影响的实用干预措施 这些年轻人中的复杂，多症状的问题。这项研究通过 测试可能影响SDOH的多组分综合预防干预措施 生物心理社会健康指标和长期健康结果。与Star House合作，倒入 Yeh中心，年龄在14至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，以便可以有效地确定基本的干预组件。尤其， 青年（n = 300）将随机分配到a）动机采访/社区加强方法 +往常 Sau，n = 80），C）Mi/Cra + Sboa + Sau（n = 80）或D）Sau（n = 60）通过倒入中心。为了评估 长期预防对药物使用，心理健康和其他结果的影响，所有年轻人都将是 在基线和3、6、12、18和24个月后进行评估。这项研究的主要目标是 建立嵌入在社区Yeh的系统中的全面干预措施的影响 下车中心，关于青年的阿片类药物和混乱，其他物质的小姐和疾病，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基础变化途径的独特信息 针对年轻的特定亚组以及成本估算，以告知未来的实施工作 全国各地。