Establishing Quality and Outcome Measures for Recovery Housing: A Tiered Approach Supporting Service Evolution.

With over one-hundred thousand drug overdose deaths in 2021, substance use disorder (SUD) is a public health crisis in the United States. Medical stabilization has been the predominant focus of SUD interventions despite low levels of retention. Consequently, national quality measures for SUD care outside the clinical continuity of care are limited. The expansion of recovery support services addressing social drivers of health outside clinical settings is needed. The current SUD quality measures are not applicable nor feasible for recovery support service providers with limited resource capacities, like the estimated 17,900 recovery housing providers nationwide. Despite widespread support for recovery housing and its documented effectiveness, no universal set of measures has been developed for widespread adoption. In this brief, a matrix of quality measures are proposed to meet the needs of recovery housing providers with various capacities to support service evolution and improve equitable SUD treatment and recovery care.

Psychometric properties of the Fletcher Recovery Housing Alliance Measure (FRHAM-12).

Background: Recovery Housing (RH), an important resource for substance use disorder (SUD) recovery, centers on shared lived experience. Program evaluation considers the contribution of environmental factors to outcomes, yet most research on outcomes has focused on patient factors and fidelity to protocols. Investigations of process measures reflecting the dynamic interplay between patient factors and the treatment program are limited. Alliance, one's perceived connection with others, is a process measure associated with mental health outcomes and includes domains "tasks," "goals," and "bonds." We posit that alliance serves as a proxy construct to measure the impact of shared experience in RH.Objectives: Develop and assess the psychometric properties of the Fletcher Recovery Housing Alliance Measure (FRHAM-12) for RH.Methods: A cross-sectional survey with the 12-item FRHAM-12 was administered to 271 individuals (60% men, 39% women, 1% other) within six RH centers in Kentucky. Item-total correlations, internal consistency reliability, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA) were conducted.Results: The FRHAM-12 was found to have a strong internal consistency (0.924 alpha coefficient) and the EFA yielded a single component (56.38% of cumulative scale variance). CFA indicated acceptable levels of absolute and relative fit of a unidimensional scale with values of 0.67 and 0.976 for the standardized root mean square residual and relative fit index.Conclusion: This study aimed to construct and validate an initial measure for RH alliance resulted in the brief, FRHAM-12; a tool with strong internal and factor validity. Future research should examine the measure's predictive and concurrent validity.

Addressing rural and non-rural substance use disorder stigma: Evidence from a national randomized controlled trial.

Background: Individuals with substance use disorder (SUD) and recovery support services often face significant social stigma, especially in rural areas. One method of addressing stigma is through education and personal recovery stories. It is unclear if such messages will work similarly across rural and non-rural areas. Methods: We conduct an exploratory analysis of data from a national randomized controlled trial (N = 2,721) to determine if there are differences in the effectiveness of messages at reducing stigma across rurality. Specifically, we test four interventions to reduce stigma: education about the effectiveness of recovery housing and three versions of a personal recovery story that varied social distance and delivery medium (identified written story, anonymous written story, and video). Results: We find that messages may not have the same effect across rurality, with non-rural participants in the identified and anonymous written recovery story groups having lower stigma scores and only rural participants exposed to the anonymous written story having lower stigma scores compared to their counterparts in the control group. Further, non-rural participants exposed to both written story treatments had higher positive feelings towards those in recovery compared to the control group, but only rural participants in the anonymous written story group had higher positive feelings compared to the control group. Conclusion: Our results suggest that messages may have different effects on stigma across rurality and that rural participants' beliefs may be particularly hard to change. Future research should examine what types of stigma reduction interventions are most effective in rural areas.

Justifying the need for a recovery related surveillance system: Exploratory focused interviews.

Background and Aims: No recovery related surveillance system exists but given the evidence of effectiveness and growing supply, a house- and resident- level recovery house (RH) surveillance system could be beneficial for data collection on recovery support service (RSS) engagement, and retention; for improved standardization of RH programs and services; and for identification of outcomes associated with long-term recovery. Methods: This study aimed to explore current data collection practices at the resident- and house- level through qualitative focus interviews of RH representatives. The 13 RH interviews were scheduled with 16 RH representative respondents. Results: The most frequently collected resident data was at entry (92%) and departure (85%) and included demographics (n = 5), substance use history (n = 6), treatment and recovery history (n = 5), legal and correctional history (n = 6) and mental health information (n = 7). Recovery support data was collected by 85% of houses. Post-stay data was only collected by four RHs (31%). Conclusion: These results indicate that there is a lack of standardized systematic collection, analysis, and reporting of recovery related data in the RH field. A recovery related surveillance system has the potential to fill this gap and inform and improve standard of resident care to support long-term recovery from substance use disorder.

State-Level Support for Recovery Housing: Results from a National Collaborative Study of U.S. Single State Agencies.

Single State Agencies (SSAs) are responsible for managing the publicly funded alcohol and other drug prevention, treatment, and recovery service system. Recovery housing (RH) is an important recovery support service (RSS) for individuals experiencing substance use disorder (SUD). Despite its effectiveness, information on state utilization and support is limited. To assess state-level support for RH and its incorporation within the SSA-managed SUD service systems, we administered a survey with SSAs in the 50 United States and the District of Columbia. In total, 48 out of the 51 SSAs responded, yielding a 94% response rate. Findings indicate strong state-level support for RH in terms of it being an integral RSS (98%), part of state-level strategic plans (73%) and prioritized for funding (87.5%). States are making progress to formalize RH with 68% reporting RH had been defined formally or within their agency. However, activities around understanding the capacity and need for RH are limited, with 44% indicating a needs assessment had not been conducted. At the same time, states perceive RH as a priority RSS, with growing recognition of its positive impact on long-term SUD recovery. This research identifies the opportunities for stakeholders to further evolve and expand RH at the federal, state, and local levels.

Health Insurance Literacy Levels of Information Intermediaries: How Prepared Are They to Address the Growing Health Insurance Access Needs of Consumers?

BACKGROUND: With rising unemployment rates brought on by coronavirus disease 2019 pandemic, the rates of underinsured and uninsured consumers are likely to rise. Health information intermediaries play a critical role in assisting consumers with navigating the complexities of the United States health care system and the ever-changing health care policy landscape. Not much is known about the health insurance literacy (HIL) levels of information intermediaries and their ability to assist consumers with making informed decisions about their health insurance. OBJECTIVE: This study aimed to examine the association between information intermediary levels of HIL, sociodemographic factors, and confidence and behaviors in assisting consumers with health insurance needs. METHODS: We surveyed 118 information intermediaries from various roles to assess objective and subjective HIL, frequency, and confidence in assisting consumers, and confidence in understanding changes in federal health reform policies and state Medicaid waiver programs. KEY RESULTS: Less than one-half (39%) of information intermediaries had high subjective HIL and much fewer (13%) had high objective HIL. The average frequency of assisting consumers with health insurance scores were somewhat low, and confidence in assisting consumers with health insurance scores and confidence with understanding state and federal policies were modest. Results from our logistic regression model indicated that confidence in assisting consumers was found to be the only significant contributor to high subjective HIL. For every one-point increase on the confidence assisting subscale, there was a 35% increase in the information intermediaries having high subjective HIL. CONCLUSIONS: Findings from this study, coupled with rising uninsured rates, indicate the need for tailored training programs and resources to equip our information intermediaries to provide timely and appropriate health insurance support for consumers. [HLRP: Health Literacy Research and Practice. 2022;6(1):e30-e36.] Plain Language Summary: In a sample of 118 information intermediaries, representing community health workers, navigators, and other people in outreach roles, the majority had low subjective and objective HIL. We also found that as confidence with assisting consumers with health insurance needs increases, HIL increased as well. These findings indicate that tailored training programs and resources are needed to equip information intermediaries to provide health insurance support for consumers.

Assessing waivered and non-waivered physician barriers to treating patients with substance use disorders: a cross-sectional Kentucky pilot.

INTRODUCTION: Opioid and other substance use disorders (OUD/SUDs) have been and continue to be significant public health issues. The standard of care for OUD is the use of medication for opioid use disorder (MOUD) in conjunction with counseling or behavioral therapies, yet research has indicated that barriers exist for patients accessing MOUD as well as for physicians prescribing MOUD due to requirements associated with the DATA 2000 waiver. METHODS: A pilot cross-sectional survey was conducted among Kentucky physicians in order to reassess common barriers as well as to explore barriers that non-waivered providers face to becoming waivered. Barriers were compared by waiver status (waiver vs. non-waivered) as well as geographic location (rural vs. non-rural). RESULTS: Compared to waivered physicians, non-waivered physicians were significantly less likely to report positive personal beliefs related to the use of MOUD for OUD and reported significantly more barriers to treating OUD patients in the areas of physicians' practice and culture, auditing, and institutional support and resources (p < .05). The majority (69%) of all physicians indicated they would benefit from a tool kit with evidence-based clinical guidelines. CONCLUSIONS: The barriers and beliefs identified in this pilot study indicate the need for policy action at the federal level to reduce barriers and incentivize more physicians to obtain waivers to treat OUD. Further, the development of brief educational resources tailored to physicians to treat OUD patients including pregnant patients with OUD is recommended.

Perceptions of opioid and other illicit drug exposure reported among first responders in the southeast, 2017 to 2018.

BACKGROUND: Opioid use has risen dramatically in recent years, and its illegal use puts first responders at risk when intervening in overdoses. Synthetic opioids, like fentanyl with a potency 50 to 100 times greater than morphine, pose a great risk and accidental exposure via ingestion, inhalation, mucosal, or percutaneous routes, can potentially lead to fatal outcomes. Anecdotal media accounts in early 2017 of accidental occupational opioid exposure among first responders generated a national concern. METHODS: To identify first responders' recollections, beliefs, and concerns about possible occupational exposure to opioids and other drugs, researchers in Kentucky, Virginia, Mississippi, and Georgia administered an emailed, anonymous convenience sample survey. RESULTS: A total of 5955 surveys were analyzed with 15% of respondents reporting they believed they had been exposed to opioids, and of those, less than 1% reported experiencing health effects from perceived exposure. Over half (51%) of respondents reported being "very or somewhat concerned" about developing health effects from exposure to opioids. Half of respondents reported being unaware of Centers for Disease Control and Prevention (CDC)/National Institutes for Occupational Safety and Health (NIOSH) guidelines for preventing occupational-related opioid exposures. CONCLUSIONS: Only a small fraction of first responders believed they had experienced symptoms related to opioid exposure in overdose response calls, but half were concerned about potential exposures and half were unaware of the educational guidance on prevention available. The high level of concern regarding potential exposure warrants the need for the development and or enhancement of targeted educational training interventions and further dissemination of pre-existing training interventions to ensure first responders have the knowledge and understanding of occupational opioid exposures and minimize stress associated with the potential rare exposures.

Trichuris suis therapy for active ulcerative colitis: a randomized controlled trial.

BACKGROUND & AIMS: Ulcerative colitis is most common in Western industrialized countries. Inflammatory bowel disease is uncommon in developing countries where helminths are frequent. People with helminths have an altered immunological response to antigens. In animal models, helminths prevent or improve colitis by the induction of regulatory T cells and modulatory cytokines. This study determined the efficacy and safety of the helminth Trichuris suis in therapy of ulcerative colitis. METHODS: This was a randomized, double blind, placebo-controlled trial conducted at the University of Iowa and select private practices. Trichuris suis ova were obtained from the US Department of Agriculture. The trial included 54 patients with active colitis, defined by an Ulcerative Colitis Disease Activity Index of > or =4. Patients were recruited from physician participants and were randomly assigned to receive placebo or ova treatment. Patients received 2500 Trichuris suis ova or placebo orally at 2-week intervals for 12 weeks. RESULTS: The primary efficacy variable was improvement of the Disease Activity Index to > or =4. After 12 weeks of therapy, improvement according to the intent-to-treat principle occurred in 13 of 30 patients (43.3%) with ova treatment compared with 4 of 24 patients (16.7%) given placebo (P = .04). Improvement was also found with the Simple Index that was significant by week 6. The difference in the proportion of patients who achieved an Ulcerative Colitis Disease Activity Index of 0-1 was not significant. Treatment induced no side effects. CONCLUSIONS: Ova therapy seems safe and effective in patients with active colitis.

Management of asymptomatically/minimally symptomatic post-ERCP serum liver test elevations: first do no harm.

Trauma to the major papilla and transient supraphysiologic biliary tract pressure during ERCP may produce transient serum liver test elevation. Further investigation of these abnormal serum tests may be costly, potentially hazardous, and unnecessary. Transient rises in post ERCP serum liver tests may be a common epiphenomenon that requires only careful clinical observation. Our aim was to study serum liver test results collected before and after ERCP in asymptomatic (or minimally symptomatic) patients and determine the natural clinical history of these patients, without further intervention. Data were collected prospectively as part of a larger study, and this subset of data on asymptomatic patients was then analyzed separately. All patients had serum liver tests done before ERCP, and 4 and 18-24 h after ERCP. Thirty-seven patients were evaluated. Sixteen of the 36 (43%) had an abnormal serum liver test after ERCP. Fifteen of the 36 had a biliary or pancreatic papillotomy done. Whether or not a patient had a papillotomy performed did not appear to influence the incidence of abnormal transient serum liver test rise. There were no biliary stents placed in any of the patients evaluated. There were two cases of post-ERCP pancreatitis (one mild; one moderate). There were no cases of cholangitis or persistent biliary tract obstruction. In conclusion, a transient rise in ERCP serum liver tests appears common following ERCP. In the absence of significant clinical signs or symptoms, these isolated serum laboratory test abnormalities should managed expectantly.