Alliance to Disseminate Addiction Prevention and Treatment (ADAPT): A Statewide Learning Health System to Reduce Substance Use among Justice-Involved Youth in Rural Communities.

传播成瘾预防和治疗联盟 (ADAPT)：一个全州范围的学习健康系统，旨在减少农村社区参与司法的青少年的药物使用。

• 批准号: 10621857
• 负责人: Matthew Aalsma
• 金额: $ 90.9万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10621857
• 关键词: Address; Adolescent; Affect; Biological Models; Caring; Cessation of life; Charge; Climate; Clinical Trials; Collaborations; Communities; Community Health; Community Mental Health Centers; Continuity of Patient Care; Cost effectiveness research; County; Data; Decision Making; Educational Intervention; Emergency department visit; Ensure; Evidence based intervention; Future; Goals; Health; Health Personnel; Health Services Accessibility; Health system; Human Resources; Hybrids; Indiana; Individual; Infrastructure; Institution; Interdisciplinary Study; Intervention; Justice; Learning; Link; Methodology; Methods; Midwestern United States; National Institute of Drug Abuse; Opioid; Outcome; Outcome Assessment; Overdose; Pharmaceutical Preparations; Policies; Population; Prevention; Public Health; Randomized; Reporting; Research; Research Support; Resource Allocation; Resource-limited setting; Risk; Role; Rural; Rural Community; Sequential Multiple Assignment Randomized Trial; Services; Site; Substance Use Disorder; System; Testing; Time; Training; Treatment Cost; Vulnerable Populations; Work; Workforce Development; Youth; addiction; administrative database; behavioral health; community based research; comparative effectiveness; disorder risk; evidence base; experience; implementation cost; implementation evaluation; implementation outcomes; implementation process; implementation science; improved; juvenile justice system; novel; opioid epidemic; opioid misuse; opioid overdose; opioid use; opioid use disorder; overdose death; programs; randomized, clinical trials; recidivism; reduced substance use; rural counties; safety outcomes; screening; substance use; success; trial design

PROJECT SUMMARY Indiana ranks 14th nationally in drug overdose deaths and, from 2016 to 2017, experienced the 3rd largest increase (22.5%) in overdose deaths. The CDC recently reported Indiana as one of only six states with a significant increase in emergency department visits for suspected opioid overdose. Yet, Hoosiers at risk for opioid misuse and other substance use disorders (SUDs) are unlikely to receive necessary services; Indiana - a largely rural state - ranks 46th in number of behavioral health treatment providers per individuals suffering addictions. By targeting rural counties in a Midwest state, our research team seeks to address the national opioid crisis at its epicenter. We will also focus on a population among those at greatest risk for opioid-related harms: youth involved in the juvenile justice system (YJJ). Among arrested youth, 78% have recently used illicit substances. Our research has shown that YJJ die at 1.5 times the rate of youth who have never been arrested, and a leading cause of YJJ death is drug overdose. The primary goal of our proposed project, Alliances to Disseminate Addiction Prevention and Treatment (ADAPT), is to address barriers to effective SUDs treatment of YJJ as identified by the substance use care cascade. We will accomplish our goal by creating alliances between the juvenile justice system (JJ) and community mental health centers (CMHCs) in 10 rural Indiana counties. These collaborative JJ-CMHC partnerships will facilitate SUD risk identification and service connection by JJ and enable timely initiation and engagement in evidence-based SUD treatment provided by CMHCs. ADAPT takes a two-pronged approach. First, we will employ a Learning Health System (LHS) model to develop alliances between JJ and CMHCs. Second, we will maximize opioid use prevention efforts by implementing a bundled treatment approach to improve screening, resource allocation, workforce development and evidence-based interventions (EBIs) that target a range of SUD risk levels. We hypothesize that ADAPT – a combination of the LHS alliances and dissemination of targeted SUD EBIs – will positively affect SUD and recidivism outcomes over time. We will conduct a hybrid type II comparative effectiveness, cluster randomized clinical trial to compare the LHS to the EBI interventions. In addition, we will employ sophisticated methodology, such as a sequential multiple assignment randomized trial (SMART) design, and leverage our expertise in linking administrative data from multiple health and justice systems, to assess these outcomes. We will utilize our expertise in implementation science, community-based research, clinical trials, cost- effectiveness research, and linking administrative databases, for research to assess the impact of these interventions on criminal recidivism and substance use outcomes, including transition to opiate use disorders and opiate overdose. We expect this project will guide future community-based efforts targeting the substance use care cascade among vulnerable populations.

项目摘要 印第安纳州在药物过量死亡中排名全国第14位，从2016年到2017年，经历了第三大 过量死亡人数增加（22.5％）。疾病预防控制中心最近报告了印第安纳州是仅有的六个州之一 可疑的阿片类药物过量的急诊务访问大幅增加。但是，Hoosiers有风险 阿片类药物和其他药物使用障碍（SUD）不太可能获得必要的服务；印第安纳州 - 在很大程度上是粗糙的状态 - 每个人的行为健康治疗提供者的数量排名第46 成瘾。通过针对中西部州的农村县，我们的研究团队试图解决国家 Opioid危机在其震中。我们还将重点关注与卵动物有关的风险最大的人口 危害：少年司法系统（YJJ）的青年。在青年中，有78％的人最近使用了非法 物质。我们的研究表明，YJJ死于从未被捕的青年率的1.5倍 YJJ死亡的主要原因是药物过量。我们提议的项目的主要目标，联盟 传播预防和治疗（ADAPT）是解决有效SUDS治疗的障碍 YJJ的使用物质使用护理级联。我们将通过建立联盟来实现我们的目标 在印第安纳州10个乡村的少年司法系统（JJ）和社区心理健康中心（CMHC）之间 县。这些协作的JJ-CMHC合作伙伴关系将促进SUD风险识别和服务 JJ的联系，并启用及时的启动和参与，以提供基于证据的SUD治疗 CMHC。 Adapt采用了两管沟的方法。首先，我们将采用学习卫生系统（LHS）模型 在JJ和CMHC之间建立联盟。其次，我们将最大化阿片类药物的预防使用 实施捆绑的治疗方法来改善筛查，资源分配，劳动力发展 以及针对一系列SUD风险水平的基于证据的干预措施（EBIS）。我们假设这种适应 - LHS联盟的结合与有针对性的SUD EBI的传播 - 将对SUD和 累犯的结果随着时间的流逝。我们将进行II型混合比较有效性，簇随机 将LHS与EBI干预措施进行比较。此外，我们将采用复杂的 方法论，例如顺序多元分配随机试验（智能）设计，并利用我们的 链接来自多个健康和司法系统的行政数据的专业知识，以评估这些结果。我们 将利用我们在实施科学，基于社区的研究，临床试验，成本 - 有效性研究并将行政数据库联系起来，以评估这些研究的影响 犯罪累犯和物质使用结果的干预措施，包括过渡以优化使用障碍 并优化过量。我们预计该项目将指导针对基板的未来基于社区的努力 在弱势群体中使用护理级联。