Justice Community Opioid Innovation Network (JCOIN): TCU Clinical Research Center

Recognizing the current opioid crisis among justice- involved individuals and the corresponding need to intervene at the intersection of justice and community health, the JCOIN study explores positive outcomes associated with a multi-level hybrid implementation approach (see opposite page). This approach capitalizes on facilitated collaboration (coaching), training, and cross-system data sharing in an effort to leverage improvements in interagency collaboration between criminal justice and community behavioral health (CBH). Ultimately, JCOIN seeks 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. Specific aims include:

1) increase access to and retention in appropriate CBH and medication treatment programs for opioid use disorders (MOUD) 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
4) examine the impact these two approaches have on individual outcomes for justice-involved individual outcomes

The JCOIN project examines both implementation fidelity and efficacy, seeking to answer the question of which implementation strategy (top down versus horizontal cascading) is most effective for rapid uptake of evidence-based practices within justice settings. The study also examines which strategy is most effective for increasing service linkage and initiation, service retention, and improved opioid-related public health safety outcomes.

A Hybrid Type 3 study design will be used mainly to compare two implementation strategies and two interventions at two levels (client and system). A secondary aim is to assess client-level outcomes associated with the trial. This design integrates two robust methodologies (stepped wedge and cluster randomized trial), and includes over a dozen clinical research performance sites (communities) located across Texas and Illinois. The multisite JCOIN CRC application includes a highly experienced team of Multiple PIs, investigators, and partners, all of which contribute to the JCOIN net- work. This network serves 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.