Expanding Access to Pregnancy Specific Opioid Use Disorder Treatment in Jail: Piloting and Adaptable Implementation Strategy to Advance Equitable and Patient-Centered Care

扩大监狱中妊娠期特定阿片类药物使用障碍治疗的机会：试点和适应性实施策略，以促进公平和以患者为中心的护理

• 批准号: 10593393
• 负责人: Carolyn Sufrin
• 金额: $ 24.56万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-15 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10593393
• 关键词: Address; Admission activity; Adoption; Advocacy; Caring; Categories; Child; Child Rearing; Collaborations; Communities; Counseling; Data; Discipline of obstetrics; Dissemination and Implementation; Drug user; Education; Elements; Ensure; Environment; Equity; Evidence based treatment; Feedback; Focus Groups; Fright; Funding; Future; Geography; Goals; Health; Health Services Accessibility; Human; Imprisonment; Individual; Infant; Infant Health; Intervention; Jail; Justice; Legal system; Life; Maternal Health; Maternal health equity; Medical; Mental Health; Methodology; Mothers; National Institute of Drug Abuse; Nature; Newborn Infant; Opioid; Outcome; Outcome Measure; Overdose reduction; Patient-Centered Care; Patient-Focused Outcomes; Personal Satisfaction; Persons; Pharmaceutical Preparations; Phase; Play; Policies; Population; Pregnancy; Pregnancy Outcome; Prenatal care; Provider; Public Health; Racial Equity; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recovery; Research; Research Personnel; Resources; Role; Sampling; Services; Shapes; Site; Surveys; System; Testing; Time; Training; Treatment outcome; Withdrawal; Woman; Work; adverse outcome; aged; clinical care; correctional system; design; effectiveness/implementation study; effectiveness/implementation trial; experience; health care delivery; health inequalities; high risk; implementation framework; implementation measures; implementation strategy; improved; improved outcome; infant outcome; innovation; intergenerational; marginalization; maternal outcome; medication for opioid use disorder; opioid epidemic; opioid use disorder; overdose death; parole; patient oriented; people of color; pregnant; probation; programs; psychosocial; public health relevance; racial disparity; recidivism; recruit; relapse risk; reproductive; scale up; service providers; social stigma; social structure; standard of care; substance use treatment; tool

Project Summary/Abstract Nearly 2 million women pass through U.S. jails each year, with nearly 8,000 admissions of pregnant people with opioid use disorder (OUD). Providing evidence-based treatment to these individuals is essential to addressing the opioid epidemic, to optimizing maternal and newborn outcomes, and to promoting maternal health equity. There is increasing recognition of the critical role of jails in providing access to medication treatment for opioid use disorder (MOUD) as a means of curbing the opioid epidemic, reducing overdose deaths, and promoting racial equity for a group of individuals who are systematically marginalized. While there is a growing number of jails that are expanding access to MOUD, strategies that are specific to the unique needs of pregnant people are lacking. Moreover, many jails still do not provide MOUD even in pregnancy, despite the well-established standard of care of avoiding withdrawal and the known benefits of MOUD specifically for pregnant individuals. Our long-term goal is to ensure that pregnant people with OUD in jails receive appropriate and timely care to optimize their long-term wellbeing and that of their infants. The overall objective is to develop and pilot an adaptable implementation strategy and toolkit for jails to be able to provide access to pregnancy-specific OUD care. The rationale is that jails vary tremendously in size, resources, and health care delivery systems, and need tools they can tailor to their environment. Ensuring jails provide access to MOUD, and in ways that are tailored to the distinctive medical, mental health and social structural aspects of care for pregnant people with OUD is essential for improving short and long-term pregnancy, recovery, and intergenerational outcomes. This project will engage multiple stakeholders, including directly impacted people, to design then pilot a patient-centered and jail-feasible implementation strategy that will facilitate and enhance jails’ implementation of MOUD for pregnant people. The strategy will contain a menu of tools to assist jails with immediate needs to provide MOUD to pregnant people entering jails; with pregnancy-tailored counseling; and with other support services and linkages to care that center the obstetrical, psychosocial, and structural needs of this population. The implementation strategy will also be adaptable to a variety of types and geographies of jails. They will then be piloted at four jails with different baseline capacities and services for MOUD for pregnant people. The steps proposed in this R34 are necessary for building the tools, outcome measures, and capacity that will be scaled-up in a future R01 hybrid implementation/effectiveness trial to improve OUD treatment access and maternal and infant health outcomes for this long-overlooked group.

项目概要/摘要 美国每年有近200万名女性入狱，其中近8000名孕妇入狱 为这些患有阿片类药物使用障碍 (OUD) 的人提供循证治疗至关重要。 解决阿片类药物泛滥问题，优化孕产妇和新生儿结局，并促进孕产妇健康 健康公平正在日益认识到监狱在提供药物获取方面的关键作用。 治疗阿片类药物使用障碍 (MOUD) 作为遏制阿片类药物流行、减少过量服用的一种手段 死亡，并促进故意偏见的群体的种族平等。 越来越多的监狱正在扩大 MOUD 的使用范围，这是针对独特监狱的特定策略 此外，许多监狱甚至在怀孕期间也不提供 MOUD， 尽管避免戒断的护理标准已确立且 MOUD 的益处众所周知 我们的长期目标是确保患有 OUD 的孕妇入狱。 接受适当和及时的护理，以优化他们及其婴儿的长期福祉。 目标是制定和试点适应性强的实施战略和工具包，以便监狱能够提供 其理由是监狱的规模、资源和条件差异很大。 医疗保健提供系统，并需要可以根据其环境定制的工具。 MOUD，并以适合独特的医疗、心理健康和社会结构方面的方式 对 OUD 孕妇的护理对于改善短期和长期妊娠、恢复和健康至关重要 该项目将吸引多个利益相关者，包括直接受影响的人， 设计并试点一项以患者为中心且在监狱中可行的实施战略，该战略将促进和加强 监狱针对孕妇实施 MOUD 该战略将包含一系列工具来协助监狱。 立即需要向入狱的孕妇提供 MOUD；以及 与以产科、心理和结构需求为中心的其他支持服务和护理联系 该战略的实施也将适应各种类型和地域的人口。 然后，他们将在四个具有不同基线能力和服务的监狱进行试点，以供 MOUD 使用。 本 R34 中提出的步骤对于构建工具、结果测量和评估是必要的。 将在未来的 R01 混合实施/有效性试验中扩大容量，以改进 OUD 这个长期被忽视的群体的治疗机会以及孕产妇和婴儿的健康结果。