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HEALing Initiative Project to Develop Opioid Use Disorder Prevention Strategies for At-Risk Adolescents as They Transition into Adulthood 

Adolescents and young adults who are 16-to-30 years of age have the highest risk for opioid use, opioid misuse, opioid use disorders, and death from overdose.

The Helping to End Addiction Long-term Initiative, a National Institutes of Health (NIH) research effort, is focusing on improving prevention and treatment for opioid misuse and addiction, as well as on enhancing pain management. The initiative consists of six focus areas, including one that focuses on developing new strategies to prevent and treat opioid use disorders through five different programs.

One of these programs is “Preventing At-Risk Adolescents Transitioning into Adulthood from Developing Opioid Use Disorder”, under which the NIH is supporting a myriad of studies that will develop and test effective strategies to prevent opioid misuse and opioid use disorder among older adolescents and young adults. The studies will focus on developing strategies for settings that can identify and reach at-risk individuals and populations, such as through health care, justice, school, and child welfare systems.

With a focus on targeting older justice-involved youth, Danica Knight, Ph.D., will serve as the lead principal investigator on a study that will be led by Texas Christian University (TCU)–one of the 23 institutions and locations that are leading studies through the HEAL initiative's program. Dr. Knight is an associate professor and a senior research scientist at the Institute of Behavioral Research at TCU.

The study led by the institution is “Preventing Opioid Use Among Justice-Involved Youth As They Transition To Adulthood: Leveraging Safe Adults" (LeSA). Dr. Kathryn McCollister, Ph.D., associate professor and director of the Division of Health Services Research and Policy at the Miller School of Medicine’s Department of Public Health Sciences, will work closely with Dr. Knight and her team to lead the economic analyses of the LeSA study. Dr. McCollister will be joined by Diana Bowser, Sc.D., M.P.H., who is an associate professor and health economist at The Heller School for Social Policy and Management at Brandeis University.

The objective of the study is to adapt and test the Trust-Based Relational Intervention (TBRI) with a goal of preventing the initiation or escalation of opioid misuse among justice-involved adolescents. TBRI is a relational, attachment-based intervention that promotes emotional regulation through interaction with responsive adults.

Researchers will target 16-to-18-year old’s who are transitioning to their communities after a period of detainment in treatment or correctional facility. Safe adults, such as a parent or guardian, will be trained in behavior management techniques for empowering youth to appropriately express their needs. The parent or guardian will also connect them with others in positive social ways, as well as correct or reshape their behavior.

The study will consist of three phases. The first will adapt elements of TBRI for juvenile-justice youth, develop intervention manuals and study protocols, examine the acceptability of the adapted intervention, and test the feasibility of the proposed study protocol, such as agency and youth recruitment. In this phase, 15 youth and safe adult dyads will be recruited.

In the second phase, researchers will examine both the effectiveness of TBRI for preventing opioid misuse and the comparative utility of three support formats, such as by including one of the following:

  • TBRI training only
  • TBRI training combined with structured coaching
  • TBRI training combined with responsive coaching.
A total of 360 youth/safe adult dyads will be recruited from six participating juvenile-justice facilities over a three-year period and followed for 18 months post-release, which would entail 20 youth and adult dyads a year and per facility.

Researchers will examine the barriers and facilitators of TBRI sustainment in the third phase. Sixty juvenile-justice staff–10 from each agency–will provide annual input through focus groups and surveys.

Project investigators at TCU will work with administrators and staff at each juvenile-justice facility to implement a sustainment plan, which will include developing in-house TBRI expertise, such as staff training and implementation assistance.

Dr. McCollister and Dr. Bowser will estimate the incremental costs and cost-effectiveness of TBRI support options relative to standard reentry practices. The economic study will also examine reductions in healthcare and criminal justice system costs to estimate the net economic impact from healthcare and societal perspectives. The healthcare sector perspective includes the direct costs of the interventions and all formal medical costs incurred by the system on behalf of patients or clients. The societal perspective includes all costs and cost-offsets flowing from the intervention, such as criminal activity costs and reduced productivity (either work or school), in addition to healthcare costs. Within these perspectives, the specific costs to the provider or correctional agency can be highlighted to describe the implementation and annual operating costs of the interventions, and budget impact to the provider/agency of adding new services or changing existing practices.

Written by Amanda Torres
Published on December 11, 2019