Rigorous Evaluation of Strategies to Prevent Overdose Through Linking People With Illicit Substance Use Disorder to Recovery Support Services
试验速览
- 阶段
- 不适用
- 状态
- 进行中（未招募）
- 发起方
- 入组人数
- 208
- 试验地点
- 1
- 主要终点
- Recovery Capital
研究概览
简要总结
This 3-year Hybrid Type 1 study will randomize 208 people with co-occurring substance use and mental health disorders (COD) referred from the Worcester Hub. This study seeks to evaluate the effectiveness of MISSION, a multi-component team approach, versus linkage with a Peer Specialist on improving outcomes among individuals with CODs. We expect that individuals receiving MISSION versus linkage only will show greater improvement in treatment engagement, substance use, and mental health outcomes. This study will also concurrently conduct a process evaluation to inform sustainability and future implementation of such interventions.
详细描述
Addiction is a growing public health problem in the United States (U.S.), with nearly 21 million Americans meeting criteria for substance use disorder (SUD), 1.6 million meeting criteria for opioid use disorder (OUD), and opioid-related overdoses have increased by 50% over the past 5 years. Among people with SUD, 49% have comorbid mental health disorders (COD). Individuals with COD are vulnerable to substance use relapses, mental illness exacerbations, overdoses, homelessness, and criminal justice involvement. However, despite the high rates of morbidity, mortality, and broad social determinant of health needs among people with COD, only 8% of individuals in the U.S. received treatment for both mental illness and SUD. Among those with a COD receiving treatment, 6-month engagement rates are as low as 16% for psychosocial treatments, and 90% of individuals leaving treatment will relapse within 12 weeks. Massachusetts is also hard hit, with a 16% higher SUD prevalence compared to the U.S., and Worcester, the second largest city in Massachusetts, is disproportionately affected by SUD, having one of the highest overdose rates in the state and is ranked 2nd on the Center for Disease Control and Prevention's social vulnerability index. These findings highlight the need to improve treatment access and engagement to support recovery in Worcester, Massachusetts. Both linkage and multicomponent wraparound models have gained popularity as a solution to increase treatment access and engagement. Maintaining Independence and Sobriety through Systems Integration, Outreach and Networking (MISSION) is a hybrid multicomponent linkage and treatment approach, providing assertive outreach linkage support combined with psychosocial treatment, delivered by a cross disciplinary team. MISSION is aligned with the Social Ecological Model (SEM) to address multilevel client needs via 3 evidence-based practices. They include 1) Critical Time Intervention (CTI), a time-limited form of assertive community treatment; 2) Dual Recovery Therapy (DRT), which is integrated group therapy for COD; and 3) Peer Support (PS), offering support for people in recovery by people in recovery. In response to Funding Opportunity Announcement (RFA-CE-22-010), the proposed 3-year Hybrid Type I study, "Supporting Treatment Access and Recovery through Linkage and Support (STAR-LS)," will recruit and randomize 208 patients with COD in Worcester, MA in the Hub, a program run by the Worcester Health and Human Services to one of the following conditions: 1) MISSION; or 2) Peer Support (linkage only). There are three specific aims: Aim 1: To evaluate the effectiveness of MISSION or compared to Peer Support to improve engagement, substance use and mental health symptoms. Aim 2: To examine mechanisms of action of the interventions. Aim 3: To conduct a sequential mixed methods process evaluation to inform sustainability and future implementation. This proposal is aligned with CDC's Strategic Priority Areas and Health People 2030 Core Objectives as it intends to improve behavioral health outcomes strengthen and sustain the recovery ecosystem for people with COD.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Are 18 or older;
- •Have a COD (1 or more substance use disorders (e.g., alcohol and illicit substances), and a mental health disorder (including depression, anxiety, trauma related disorders, bipolar, and/or schizophrenia);
- •Are in the Hub; and
- •Are not engaged in other ongoing multi-component treatment for COD with a behavioral health treatment provider or have not seen their provider for at least 3 months.
排除标准
- •We will exclude individuals who are acutely psychotic, acutely suicidal with a plan, or homicidal
- •Or with concurrent severe alcohol use disorder or high dose benzodiazepine requiring detoxification.
研究组 & 干预措施
Full MISSION
Participants assigned to this condition will receive full MISSION services. MISSION services include 6-months of integrated mental health and substance use treatment and treatment planning with the MISSION Case Manager (13 session curriculum) and Peer Support Specialist (11 session curriculum). Content of these sessions will be directed using the MISSION Treatment Manual and Consumer Workbooks. MISSION teams will also provide linkages and supports to treatment services within the participant's community throughout the duration of the study.
干预措施: Full MISSION (Behavioral)
Linkage Only Delivered by a Peer Specialist
Our Linkage only arm delivered by a Peer Specialist will act as the comparison group to the MISSION arm. Participants randomized to the linkage only arm will receive 6-months of linkage care from a Peer Specialist. The Peer Specialist will provide informal treatment planning as well as linkages and support to community services, but will not provide integrated dual disorders treatment, nor will this arm utilize any MISSION materials or offer Peer led groups.
干预措施: Linkage Only Delivered by a Peer Specialist (Behavioral)
结局指标
主要结局
Recovery Capital
时间窗: 9-months
Measured by Assessment of Recovery Capital (ARC)
Mental Health Functioning
时间窗: 9-months
Measured by self-report mental health symptoms on Behavior and Symptom Identification Scale (BASIS-24)
Mental Health Impairment
时间窗: 9-months
Measured by self-report on World Health Organization Disability Assessment (WHODAS 2.0)
Fidelity to Intervention
时间窗: Weekly
Measured via clinical staff submitting weekly treatment fidelity logs
Alcohol or other drug 12-Step Participation
时间窗: 9-months
Measured by self-report using the Alcoholics Anonymous Inventory (AAI)
Overdose Risk
时间窗: 9-months
Self-report using the Overdose Risk Questionnaire (OdRi)
Suicide Severity
时间窗: Screening
Self-report using the Columbia-Suicide Severity Rating Scale (C-SSRS)
PTSD Symptoms
时间窗: 9-months
Measured by self-report PTSD symptoms on Patient Checklist (PCL-5)
Therapeutic Alliance Client
时间窗: 9-months
Measured by Working Alliance Inventory-C
Feasibility of Intervention
时间窗: 6-months
Using the Feasibility of Intervention Measure (FIM)
Health functioning
时间窗: 9-months
Measured by the World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF)
Satisfaction with Care
时间窗: 6-months
Self-report using the Treatment Satisfaction Questionnaire
Psychiatric Severity
时间窗: 9-months
Measured by Structured Clinical Interview for Diagnostic Statistical Manual (DSM)-5 (SCID-RV)
Therapeutic Alliance Therapist
时间窗: 9-months
Measured by Working Alliance Inventory-T
Baseline Demographics
时间窗: Baseline
Self-reported using the Addiction Severity Index (ASI)
Acceptability & Appropriateness
时间窗: 6-months
Using the The Acceptability of Intervention Measure (AIM) and Intervention Appropriateness Measure (IAM)
Self-report opioid use and other substance use
时间窗: 9-months
Measured by self-report days of use using the Time-line Follow Back (TLFB)
Number of Outreach and Linkage Sessions
时间窗: 9-months
Self-reported using the Psychosocial Treatment \& Healthcare Services Tracking Sheet
Community Health & Social Needs
时间窗: Baseline
Self-report using the Accountable Health Communities \& Health-Related Social Needs
Self-report opioid use and other substance use
时间窗: Baseline
Measured by self-report days of use using the Time-line Follow Back (TLFB)
Self-report opioid use and other substance use
时间窗: 3-months
Measured by self-report days of use using the Time-line Follow Back (TLFB)
Self-report opioid use and other substance use
时间窗: 6-months
Measured by self-report days of use using the Time-line Follow Back (TLFB)
Mental Health Functioning
时间窗: Baseline
Measured by self-report mental health symptoms on Behavior and Symptom Identification Scale (BASIS-24)
Mental Health Functioning
时间窗: 3-months
Measured by self-report mental health symptoms on Behavior and Symptom Identification Scale (BASIS-24)
Mental Health Functioning
时间窗: 6-months
Measured by self-report mental health symptoms on Behavior and Symptom Identification Scale (BASIS-24)
PTSD Symptoms
时间窗: Baseline
Measured by self-report PTSD symptoms on Patient Checklist (PCL-5)
PTSD Symptoms
时间窗: 3-months
Measured by self-report PTSD symptoms on Patient Checklist (PCL-5)
PTSD Symptoms
时间窗: 6-months
Measured by self-report PTSD symptoms on Patient Checklist (PCL-5)
Mental Health Impairment
时间窗: Baseline
Measured by self-report on World Health Organization Disability Assessment (WHODAS 2.0)
Mental Health Impairment
时间窗: 3-months
Measured by self-report on World Health Organization Disability Assessment (WHODAS 2.0)
Mental Health Impairment
时间窗: 6-months
Measured by self-report on World Health Organization Disability Assessment (WHODAS 2.0)
Psychiatric Severity
时间窗: Screening
Measured by Structured Clinical Interview for Diagnostic Statistical Manual (DSM)-5 (SCID-RV)
Psychiatric Severity
时间窗: Baseline
Measured by Structured Clinical Interview for Diagnostic Statistical Manual (DSM)-5 (SCID-RV)
Psychiatric Severity
时间窗: 3-months
Measured by Structured Clinical Interview for Diagnostic Statistical Manual (DSM)-5 (SCID-RV)
Psychiatric Severity
时间窗: 6-months
Measured by Structured Clinical Interview for Diagnostic Statistical Manual (DSM)-5 (SCID-RV)
Health functioning
时间窗: Baseline
Measured by the World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF)
Health functioning
时间窗: 3-months
Measured by the World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF)
Health functioning
时间窗: 6-months
Measured by the World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF)
Therapeutic Alliance Client
时间窗: Baseline
Measured by Working Alliance Inventory-C
Therapeutic Alliance Client
时间窗: 3-months
Measured by Working Alliance Inventory-C
Therapeutic Alliance Client
时间窗: 6-months
Measured by Working Alliance Inventory-C
Therapeutic Alliance Therapist
时间窗: Baseline
Measured by Working Alliance Inventory-T
Therapeutic Alliance Therapist
时间窗: 3-months
Measured by Working Alliance Inventory-T
Therapeutic Alliance Therapist
时间窗: 6-months
Measured by Working Alliance Inventory-T
Recovery Capital
时间窗: Baseline
Measured by Assessment of Recovery Capital (ARC)
Recovery Capital
时间窗: 3-months
Measured by Assessment of Recovery Capital (ARC)
Recovery Capital
时间窗: 6-months
Measured by Assessment of Recovery Capital (ARC)
Alcohol or other drug 12-Step Participation
时间窗: Baseline
Measured by self-report using the Alcoholics Anonymous Inventory (AAI)
Alcohol or other drug 12-Step Participation
时间窗: 3-months
Measured by self-report using the Alcoholics Anonymous Inventory (AAI)
Alcohol or other drug 12-Step Participation
时间窗: 6-months
Measured by self-report using the Alcoholics Anonymous Inventory (AAI)
Overdose Risk
时间窗: Baseline
Self-report using the Overdose Risk Questionnaire (OdRi)
Overdose Risk
时间窗: 3-months
Self-report using the Overdose Risk Questionnaire (OdRi)
Overdose Risk
时间窗: 6-months
Self-report using the Overdose Risk Questionnaire (OdRi)
Number of Outreach and Linkage Sessions
时间窗: Baseline
Self-reported using the Psychosocial Treatment \& Healthcare Services Tracking Sheet
Number of Outreach and Linkage Sessions
时间窗: 3-months
Self-reported using the Psychosocial Treatment \& Healthcare Services Tracking Sheet
Number of Outreach and Linkage Sessions
时间窗: 6-months
Self-reported using the Psychosocial Treatment \& Healthcare Services Tracking Sheet
次要结局
未报告次要终点
研究者
David Smelson
Professor
University of Massachusetts, Worcester