BRIDGE: Building Resilient Initiatives for Deflection through Greater Engagement

The BRIDGE to Deflection Project is a five-year NIH NIDA-funded clinical research study, that is part of the Justice Community Overdose Innovation Network (JCOIN) 2.0. The purpose of the network is to bring together a national consortium of investigators and practitioner partners to conduct an array of research and capacity building activities to improve the delivery of effective interventions for adults and youth, spanning the key points of the sequential intercept model.

The project acknowledges the critical need for rigorous studies that focus on testing the implementation of strategies to prevent opioid-related morbidity and mortality among individuals at risk for being involved in the criminal legal system (CLS). To address this crisis, novel collaborative efforts between public safety and health sectors have been implemented, including Deflection initiatives. These efforts aim to deflect individuals away from initial or further involvement with the CLS and toward substance use (SU) treatment services in the community, ultimately working to reduce overdose deaths and encounters with EMS.

While the barriers to adopting Deflection are well-documented and Deflection is widely regarded as a promising practice, there remains a significant need for research focused on identifying the most effective implementation strategies that contribute to sustained positive outcomes.

The BRIDGE to Deflection Project aims to:

• Significantly enhance our understanding of public health outcomes (e.g., overdose incidents and substance-use [SU]-related Emergency Medical Service [EMS] contacts) and public safety outcomes (e.g., drug-related arrests) associated with Deflection.
• Create a lasting contribution to the fields of research focused on SU and the criminal legal system (CLS) by advancing knowledge of effective implementation strategies involving the critical role of community engagement in Deflection.

A Hybrid Type 3 implementation-effectiveness design is used to test two strategy bundles to promote Deflection through:

• CORE community engagement bundle – designed to facilitate community engagement.
• ENHANCED community engagement bundle – CORE plus a component to systematically involve community advocates.

These strategies are tested on outcomes including reducing EMS encounters, overdose rates, overdose mortality, and improving SU service cascade outcomes associated with access, engagement, and retention among people who use drugs (PWUD).

The randomized control trial includes a total of 20 geographically distinct clinical research performance sites (i.e., 20 communities spanning 5 states: New Mexico, Illinois, Wisconsin, Colorado, and Pennsylvania), with 3–5 communities per state. Each site is comprised of community law enforcement agencies (police, sheriff, district attorney) involved in existing Deflection efforts, with community-based SU providers who serve (or potentially could serve) Deflection participants.

The project is a partnership between highly experienced Multiple PIs at TCU, senior-level collaborators from both Deflection and Community Behavioral Health (CBH), state-level evaluation partners, a national stakeholder advisory group, and CLS and behavioral health partners within each community.

The randomized control trial includes 20 geographically distinct clinical research performance sites (i.e., 20 communities spanning 5 states: New Mexico, Illinois, Wisconsin, Colorado, and Pennsylvania), with 3–5 communities per state.

Each site includes community law enforcement agencies (police, sheriff, district attorney) involved in existing Deflection efforts, paired with community-based SU providers who serve (or potentially could serve) Deflection participants.

The BRIDGE to Deflection Project represents the opportunity to develop strategies that incorporate community engagement and advocacy as core components of generalizable Deflection models designed to meet the complex needs of individuals with SU problems, and help avoid initial or escalated involvement in the criminal legal system.