Developing and Testing Innovative Care Pathways for Screening and Treatment of OUD/PTSD in Jails

开发和测试监狱中 OUD/PTSD 筛查和治疗的创新护理途径

• 批准号: 10812703
• 负责人: Nickolas D Zaller
• 金额: $ 91.56万
• 依托单位: UNIV OF ARKANSAS FOR MED SCIS
• 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 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10812703
• 关键词: Address; Adoption; Adult; Arkansas; Caring; Cause of Death; Clinical Trials; Communities; Consolidated Framework for Implementation Research; Criminal Justice; Data; Disease; Disparity; Drug usage; Effectiveness; Elements; Eligibility Determination; Enrollment; Evaluation; Evidence based intervention; Female; Goals; Healthcare; Helping to End Addiction Long-term; Hybrids; Imprisonment; Individual; Intervention; Interview; Jail; Justice; Link; Measures; Mental Health; Methods; Modeling; National Institute of Drug Abuse; Opioid; Outcome; Participant; Pathway interactions; Patients; Persons; Phase; Post-Traumatic Stress Disorders; Prisons; Provider; Quality of Care; Randomized; Records; Research; Research Support; Sampling; Services; Severities; Source; Strategic Planning; Surveys; Symptoms; Testing; Translating; Treatment outcome; United States National Institutes of Health; Victimization; Vision; Vulnerable Populations; Work; brief intervention; comorbidity; design; effectiveness evaluation; effectiveness outcome; effectiveness-implementation RCT; effectiveness/implementation design; evidence base; experience; implementation evaluation; implementation outcomes; implementation science; improved; improved outcome; innovation; medication for opioid use disorder; meetings; novel; novel strategies; operation; opioid overdose; opioid use disorder; research to practice; response; scale up; screening; screening, brief intervention, referral, and treatment; secondary outcome; violence victimization

Project Summary Opioid overdose is the leading cause of death among people recently released from incarceration. Yet, while there is growing research on opioid use disorder (OUD) and medications for OUD (MOUD) in jails and prisons, studies find that few people who are referred to post-release community MOUD initiate treatment. Emerging research suggests that therapy for posttraumatic stress disorder (PTSD), a common and deleterious OUD comorbidity, could profoundly increase the likelihood of MOUD engagement; however, this has not been tested in jails and considerable work to first tailor PTSD screening and treatment to jails and to people with OUD/PTSD in this setting would be required. Therefore, this 6-year R61/R33 aims to develop and test innovative approaches to PTSD screening and treatment among people who are eligible for jail-based OUD services. In the R61, we will form a coalition of carceral, community, and academic stakeholders to collaboratively adapt the Screening, Brief Intervention, and Referral to Treatment model to the jail context and to the needs of jailed adults with OUD/PTSD (SBIRT-J). In the R33, we will 1) assess the implementation outcomes of SBIRT-J for linking jailed adults with OUD/PTSD to therapy for PTSD via a summative evaluation guided by the Consolidated Framework for Implementation Research and 2) assess the effectiveness and implementation outcomes of competing models of PTSD therapy timing. To evaluate the latter, we will use a patient-randomized Hybrid type I implementation-effectiveness design in which jailed adults identified as having OUD/PTSD through the SBIRT-J model are randomly assigned to either immediate initiation of therapy for PTSD in jail or initiation of PTSD therapy upon release. Our primary effectiveness outcome will be post- release MOUD initiation at 6-months post-release from jail; secondary outcomes will include MOUD retention, OUD severity, PTSD symptoms, victimization, and additional drug use. Participants in the effectiveness portion of the trial (N = 304; 50% female) will be enrolled from the largest jail in Arkansas. Importantly, our study vision aligns with NIDA's Strategic Plan, as we aim to “support research to scale up the application of evidence- based interventions for SUDs, including in justice settings” (Goal 4.3). Our overall goal is to translate research to practice to increase the provision of high-quality care for justice-involved persons with OUD, consistent with the goals of NIH's HEAL Initiative. Indeed, this study will be the first trial of a treatment for PTSD in jails as a method for improving OUD outcomes, providing foundational information on PTSD as a novel intervention target for meeting the needs of a particularly vulnerable population and providing the implementation data to inform rapid scale-up if effective.

项目概要 然而，阿片类药物过量是最近刑满释放人员死亡的主要原因。 监狱和监狱中对阿片类药物使用障碍 (OUD) 和 OUD 药物 (MOUD) 的研究日益增多， 研究发现，很少有被转介到出院后社区 MOUD 的人开始接受治疗。 研究表明，治疗创伤后应激障碍（PTSD）是一种常见且有害的 OUD 合并症，可能会大大增加 MOUD 参与的可能性，但这尚未经过测试； 在监狱中进行大量工作，首先为监狱和患有创伤后应激障碍的人量身定制 PTSD 筛查和治疗 因此，在这种情况下需要 OUD/PTSD，因此，这个为期 6 年的 R61/R33 旨在开发和测试。 对有资格接受监狱 OUD 的人进行 PTSD 筛查和治疗的创新方法 在 R61 中，我们将组建一个由监狱、社区和学术利益相关者组成的联盟，以提供服务。 协作调整筛查、简短干预和转介治疗模式以适应监狱环境， 满足患有 OUD/PTSD 的被监禁成年人 (SBIRT-J) 的需求 在 R33 中，我们将 1) 评估实施情况。 SBIRT-J 通过总结性评估将患有 OUD/PTSD 的被监禁成年人与 PTSD 治疗联系起来的结果 以实施研究综合框架为指导，2) 评估有效性和 PTSD 治疗时机竞争模型的实施结果 为了评估后者，我们将使用 患者随机混合 I 型实施有效性设计，其中被监禁的成年人确定为 通过 SBIRT-J 模型患有 OUD/PTSD 被随机分配到立即开始治疗 对于监狱中的 PTSD 或出狱后开始 PTSD 治疗，我们的主要有效性结果将是在出狱后。 出狱后 6 个月启动 MOUD，次要结果包括 MOUD 保留； OUD 严重程度、PTSD 症状、受害情况和其他药物使用效果部分的参与者。 试验的参与者（N = 304；50% 为女性）将从阿肯色州最大的监狱招募。重要的是，我们的研究愿景。 与 NIDA 的战略计划保持一致，因为我们的目标是“支持研究以扩大证据的应用—— 基于 SUD 的干预措施，包括司法环境中的干预措施”（目标 4.3）。 实践增加为 OUD 涉司法人员提供高质量护理，符合 事实上，这项研究将是在监狱中治疗 PTSD 的首次试验。 改善 OUD 结果的方法，作为一种新型干预措施提供 PTSD 的基础信息 满足特别弱势群体的需求并向其提供实施数据的目标 如果有效，请告知快速扩大规模。