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：
10663762
负责人：
KYM R AHRENS
金额：
$ 33.64万
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/10663762
关键词：
Address Administrative Supplement Adolescent Adolescent and Young Adult Adult Affect Age Assertiveness Back Black race Budgets COVID-19 Caregivers Caring Censuses Communities Cost Analysis Crime Data Development Dose Drops Education Effectiveness Enrollment Exclusion Criteria Feedback Food Frequencies Funding Goals Grant Hispanic Hybrids Imprisonment Incentives Intervention Justice Latinx Legal system Length Measures Methods Modeling National Institute of Drug Abuse Opioid Outcome Participant Patient Self-Report Pediatric Hospitals Persons Phase Police Population Positioning Attribute Prevention strategy Prevention trial Process Protocols documentation Psychological reinforcement Qualifying Regulation Rehabilitation therapy Research Research Design Rewards Risk Risk Factors Sample Size Self Administration Sequential Multiple Assignment Randomized Trial Social Distance Substance Use Disorder Surveys System Testing Time Trauma Universities Washington Work Youth adaptive intervention aged base coronavirus disease cost court disorder prevention experimental study group intervention intervention effect member motivational enhancement therapy motivational intervention non-opioid analgesic opioid epidemic opioid overdose opioid use opioid use disorder overdose death parent grant participant retention pilot test prevent preventive intervention primary outcome programs recidivism recruit reduced substance use retention rate secondary outcome substance use telehealth therapy design trend trial design virtual

项目摘要

PROJECT SUMMARY Opiate use and overdose deaths have been rising, especially during COVID. Youth involved with the legal system (YILS) have some of the highest rates of opioid use disorder (OUD); local rates in the Washington State Juvenile Rehabilitation (WSJR) system approach 1 in 3 youth. Nationwide, most YILS engage in problematic non-opioid substance use, a critical risk factor for OUD. Non-opioid substance use disorders (SUDs) and OUDs, in turn, are two of the most important predictors of subsequent re-involvement in juvenile or criminal systems. In a 5-year UG3/UH3 grant, Seattle Children’s Hospital (SCH), University of Washington (UW), and WSJR are collaboratively evaluating OUD prevention interventions of varying intensities based on the Adolescent Community Reinforcement Approach with Assertive Continuing Care (ACRA/ACC). Multiple studies have established ACRA/ACC effectiveness in reducing SUD; however, none have evaluated it as OUD prevention. We are using SMART methods to construct ahigh-quality adaptive intervention (AI) containing ACRA/ACC- based OUD prevention strategies of two different intensities. In our 2-year UG3 phase, we conducted a pilot SMART experiment with 31 YILS. In our 3-year UH3 phase, we are conducting a full SMART trial with YILS aged 15-25 to compared effects of our prevention interventions during the following stages: a) as youth transition out of confinement (stage 1), and b) once they are back in the community (stage 2). We administer self-report electronic surveys at baseline, 1, 3, & 6 months to collect 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); we will use administrative data to measure recidivism. We are also conducting comprehensive cost analyses. Currently, we have achieved recruitment and retention rates that exceeded our goals as written in the parent grant (72% and 76%). However, due to increasing OUD rates resulting in a smaller proportion of current WSJR YILS qualifying for inclusion in this opioid prevention trial, longer average sentence lengths, and COVID reductions in census, we are recruiting at ~half of the weekly rate we originally anticipated. At the current rates, 187 youth will finish the study. This will allow us to assess stage 1 intervention effects on primary outcomes but could limit our ability to assess stage 1 effects on some secondary outcomes or stage 2 effects. In the present administrative supplement, we seek to mitigate COVID effects on sample size via increased incentives, increased budget for food rewards (which are a standard part of ACRA/ACC), as well as increases in recruiter/surveyor and interventionist FTEs. We seek to boost both recruitment and retention rates to 85%, which will allow us to enroll and retain at least 292 and 248 YILS, respectively. These added participants will increase our power to detect main effects on primary outcomes from 80% to 87 and will provide sufficient power to assess small/moderate stage 1 effects on secondary outcomes and stage 2 effects.

项目概要阿片类药物的使用和过量死亡人数一直在上升，尤其是在新冠疫情期间。系统 (YILS) 是华盛顿州阿片类药物使用障碍 (OUD) 发病率最高的地区之一；青少年康复 (WSJR) 系统在全国范围内帮助三分之一的青少年从事有问题的活动。非阿片类物质使用，非阿片类物质使用障碍 (SUD) 和 OUD 的关键危险因素，反过来，这是随后重新卷入青少年或犯罪系统的两个最重要的预测因素。为期 5 年的 UG3/UH3 资助，西雅图儿童医院 (SCH)、华盛顿大学 (UW) 和 WSJR 根据青少年的情况，协作评估不同强度的 OUD 预防干预措施积极持续护理的社区强化方法 (ACRA/ACC) 已有多项研究。 ACRA/ACC 确定了减少 SUD 的有效性；但是，没有人将其评估为 OUD 预防。我们正在使用 SMART 方法构建包含 ACRA/ACC- 的高质量自适应干预 (AI) 基于两种不同强度的 OUD 预防策略在我们为期 2 年的 UG3 阶段，我们进行了试点。 31 YILS 的 SMART 实验在我们为期 3 年的 UH3 阶段，我们正在对 31 YILS 进行全面的 SMART 试验。 15-25 比较我们的预防干预措施在以下阶段的效果：a) 随着青少年的过渡监禁（第 1 阶段），以及 b) 一旦他们返回社区（第 2 阶段），我们将进行自我报告。在基线、1、3 和 6 个月进行电子调查，收集主要结果的数据（启动和升级使用任何物质的天数和频率来衡量）和次要结果（数量使用特定物质（包括阿片类药物）的天数/频率）；我们将使用管理数据来衡量目前我们也在进行全面的成本分析，已经实现了招募。和保留率超出了我们在家长补助金中所写的目标（72％和76％）。增加 OUD 利率导致当前 WSJR YILS 有资格纳入此范围的比例较小阿片类药物预防试验、更长的平均刑期以及人口普查中新冠病毒的减少，我们正在招募〜我们最初预期的每周速度的一半按目前的速度，将有 187 名青少年完成这项研究。允许我们评估第一阶段干预对主要结果的影响，但可能会限制我们评估第一阶段的能力对某些次要结果或第二阶段影响的影响在本行政补充中，我们力求做到这一点。通过增加激励措施、增加食品奖励预算（包括 ACRA/ACC 的标准部分），以及招聘人员/调查员和干预人员 FTE 的增加。将招聘率和保留率提高到 85%，这将使我们能够注册并保留至少 292 人和 248 人这些添加的参与者将分别增加我们检测主要影响的能力。结果从 80% 到 87，并将提供足够的力量来评估对次要结果和第二阶段效应。