Reducing Opioid and Other Drug Use in Justice-Involved Emerging Adults Using Paraprofessional Coaches (With and Without Lived Experience) to Deliver Effective Services in a Non-Treatment Setting

Brief Summary

Detailed Description

Criminal legal system involved emerging adults are one of the highest-risk populations for opioid and other substance use and other significant problems (criminal behaviors), but they lack access to and engagement in evidence-based practices. The deleterious outcomes and long-term costs of substance use for emerging adults, communities, and society (estimated at over $740 billion annually and greater than costs for any other health problem), make this a priority. This pilot project is aimed at using paraprofessional coaches to increase engagement and access to evidence-based practices (i.e., contingency management for substance use and vocational/educational coaching) for emerging adults with substance use and criminal legal system involvement. In partnership with parole and probation, sixty emerging adults with substance use will be randomized to work with twenty paraprofessional coaches either with or without lived experience (i.e., successful substance use recovery and/or adult criminal legal system involvement). Although using peer paraprofessional coaches (those with lived experience) is becoming more popular and supported at the federal level, the outcome of this work on the paraprofessional coaches themselves, especially for emerging adults, is largely unexplored. The proposed study will use both quantitative and qualitative methods to assess feasibility and acceptability of the services and research protocols and to gain a better understanding of the impacts on both the coaches and their emerging adult clients. As substance use and poor vocational/educational attainment greatly increases the likelihood of recidivism, innovative strategies to reduce opioid and other substance use for emerging adults is critical, along with understanding the effects on the service providers (i.e., paraprofessional coaches). Aim 1: Determine the feasibility of paraprofessional coaches to deliver (with high adherence) the established interventions to emerging adults with substance use and criminal legal system involvement as part of probation and parole services, and explore differences in the delivery of the interventions based on lived experience. Aim 2: Compare emerging adult clients' engagement (attendance, completion of the intervention) and outcomes (substance use, vocational/educational attainment, criminal recidivism), when interventions are delivered by paraprofessional coaches with vs. without lived experience. Aim 3: For paraprofessional coaches delivering the interventions, examine the differences over time between those with vs. without lived experience on their own substance use symptoms and substance use relapse risk factors.

Primary Outcomes

Secondary Outcomes

• Changes from baseline to 6 months post-baseline in Emerging Adult Service Utilization (measured at 0, 4, and 6 months).(Baseline to 6 months)
• Changes from baseline to 6 months post-baseline in Emerging Adult Client Abstinence Self Efficacy (measured at 0, 4, and 6 months).(Baseline to 6 months)
• Levels of services Emerging Adult Client Satisfaction with Treatment (measured at 4 and 6 months).(Baseline to 6 months)
• Changes from baseline to 6 months post-baseline in Emerging Adult Substance Use and Problems (measured at 0, 4, and 6 months).(Baseline to 6 months)
• Changes from baseline to 6 months post-baseline in Emerging Adult Client Vocational and Educational Attainment (measured at 0, 4, and 6 months).(Baseline to 6 months)
• Changes from baseline up to 30 months post-baseline in Paraprofessional Coach Recovery Capital (measured at 0, 6, 12, 18, 24, and 30 months).(Baseline to 30 months)
• Changes from baseline to 6 months post-baseline in Emerging Adult Criminal Legal System Involvement (measured at 0, 4, and 6 months).(Baseline to 6 months)
• Changes from baseline to 6 months post-baseline in Emerging Adult Client Quality of Relationship with Paraprofessional Coach (measured at 0, 4, and 6 months).(Baseline to 6 months)
• Changes from baseline to 6 months post-baseline in Emerging Adult Recovery Capital (measured at 0, 4, and 6 months).(Baseline to 6 months)
• Changes from client's 18th birthday to 6 months post-baseline in Emerging Adult Client Arrests.(From client's 18th birthday to 6 months post-baseline)
• Changes from client's 18th birthday to 6 months post-baseline in Emerging Adult Client Charges.(From client's 18th birthday to 6 months post-baseline)
• Changes from baseline to 6 months in Emerging Adult Client Session Attendance and Vocational/Educational Activity Completion (measured at 1, 2, 3, 4, 5, and 6 months).(Baseline to 6 months)
• Changes from baseline to up to 30 months post-baseline in Paraprofessional Coach Abstinence Self Efficacy (measured at 0, 6, 12, 18, 24, and 30 months).(Baseline to 30 months)
• Changes from client's 18th birthday to 6 months post-baseline in Emerging Adult Client Incarcerations.(Client's 18th birthday to 6 months)
• Changes from baseline up to 30 months post-baseline in Paraprofessional Coach Client Vocational and Educational Attainment (measured at 0, 6, 12, 18, 24, and 30 months).(Baseline to 30 months)
• Changes from baseline up to 30 months post-baseline in Paraprofessional Coach Substance Use and Problems (measured at 0, 6, 12, 18, 24, and 30 months).(Baseline to 30 months)
• Changes from post-training to post-service delivery on attitudes towards the training, supervision, and implementation of the services delivery (measured at approximately 1, 6, and 12 months).(Post-training, an average of one month, to post-service delivery of two more clients, an average of one year)
• Changes from client's 18th birthday to 6 months post-baseline in Emerging Adult Client Convictions.(From client's 18th birthday to 6 months post-baseline)
• Rates of post-services Services Completion.(Post-services, an average of 6 months)
• Changes from baseline to up to 30 months post-baseline in Paraprofessional Coach Attitudes Toward Medications for Opioid Use Disorder (MOUD) (measured at 0, 6, 12, 18, 24, and 30 months).(Baseline to 30 months)
• Changes from baseline up to 30 months post-baseline in Paraprofessional Coach Perceptions of Feasibility of the PEERS Intervention (measured at 0, 6, 12, 18, 24, and 30 months).(Baseline to 30 months)
• Changes from baseline up to 30 months post-baseline in Paraprofessional Coach Quality of Life (measured at 0, 6, 12, 18, 24, and 30 months).(Baseline to 30 months)
• Differences in themes derived from 60 audio-recorded sessions tapes varied across paraprofessional coaches, emerging adult clients, session number, and project timeline from Paraprofessional Coaches With and Without Lived Experience (measured monthly).(Across Services Delivery, an average of 6 months)
• Changes from Baseline scores compared to up to 30 months post-baseline in Paraprofessional Coach Contingency Management (CM) Adherence (measured monthly for 30 months).(Baseline to 30 months)
• Attitudes at 6 months post-baseline in Emerging Adult Client Attitudes Toward the Services Provided (measured at 6 months).(6 months)
• Changes from baseline up to 30 months post-baseline in Paraprofessional Coach Perceptions of Acceptability of the PEERS Intervention (measured at 0, 6, 12, 18, 24, and 30 months).(Baseline to 30 months)
• Changes from baseline up to 30 months post-baseline in Paraprofessional Coach Perceptions of PEERS Intervention Appropriateness (measured at 0, 6, 12, 18, 24, and 30 months).(Baseline to 30 months)