Recognizing the current opioid crisis among justice-involved individuals and the need to intervene at the intersection of justice and community health, the current study proposes to explore positive outcomes associated with a multi-level hybrid implementation approach. The strategy capitalizes on facilitated collaboration (coaching), training, and cross-system data sharing in an effort to leverage improvements in criminal justice and community behavioral health (CBH) interagency collaboration. The ultimate goal of the proposed project is to improve local community public health and safety outcomes for reentering justice-involved individuals who have a history of (or are at risk for) using opioids. Our specific aims are to 1) increase access to and retention in appropriate CBH and medical (MAT) services for reentering justice-involved individuals who have a history of or are at risk for opioid use, 2) improve outcomes (including costs) associated with public health and safety; 3) compare two implementation approaches on systems-level outcomes designed to increase service initiation and receipt with respect to implementation and service outcomes; and 4) examine the impact of these two approaches on justice-involved individual outcomes. The proposed study examines both Implementation and Implementation-Effectiveness, seeking to answer the questions of which implementation strategy (bottom up versus horizontal cascading) is most effective for rapid uptake of evidence-based practices within justice settings.
The study also examines which implementation strategy is most effective for increasing service linkage and initiation, services retention, and improved opioid-related public health safety outcomes. A Hybrid Type 3 study design will be used and include a primary aim to compare two implementation strategies and two interventions at two levels (client and system), and a secondary aim to assess client-level outcomes associated with the trial. The study design will integrate 2 robust methodologies (stepped wedge and cluster randomized trial), and will include 18 clinical research performance sites (communities) located in Texas, New Mexico and Illinois. The proposed multi-site JCOIN CRC application includes a highly experienced team of Multiple PIs, investigators, and partners, and will contribute to the JCOIN network in an effort to establish a national consortium of investigators examining promising approaches designed to improve the capabilities and capacity of the justice system to more effectively address the opioid epidemic.