Referral to and engagement in substance use disorder treatment within opioid intervention courts in New York: a qualitative study of implementation barriers and facilitators.

BACKGROUND: People with opioid use disorder (OUD) are frequently in contact with the court system and have markedly higher rates of fatal opioid overdose. Opioid intervention courts (OIC) were developed to address increasing rates of opioid overdose among court defendants by engaging court staff in identification of treatment need and referral for opioid-related services and building collaborations between the court and OUD treatment systems. The study goal was to understand implementation barriers and facilitators in referring and engaging OIC clients in OUD treatment. METHODS: Semi-structured interviews were conducted with OIC stakeholders (n = 46) in 10 New York counties in the United States, including court coordinators, court case managers, and substance use disorder treatment clinic counselors, administrators, and peers. Interviews were recorded and transcribed and thematic analysis was conducted, guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, employing both inductive and deductive coding. RESULTS: Results were conceptualized using EPIS inner (i.e., courts) and outer (i.e., OUD treatment providers) implementation contexts and bridging factors that impacted referral and engagement to OUD treatment from the OIC. Inner factors that facilitated OIC implementation included OIC philosophy (e.g., non-punitive, access-oriented), court organizational structure (e.g., strong court staff connectedness), and OIC court staff and client characteristics (e.g., positive medications for OUD [MOUD] attitudes). The latter two also served as barriers (e.g., lack of formalized procedures; stigma toward MOUD). Two outer context entities impacted OIC implementation as both barriers and facilitators: substance use disorder treatment programs (e.g., attitudes toward the OIC and MOUD; operational characteristics) and community environments (e.g., attitudes toward the opioid epidemic). The COVID-19 pandemic and bail reform were macro-outer context factors that negatively impacted OIC implementation. Facilitating bridging factors included staffing practices that bridged court and treatment systems (e.g., peers); barriers included communication and cultural differences between systems (e.g., differing expectations about OIC client success). CONCLUSIONS: This study identified key barriers and facilitators that OICs may consider as this model expands in the United States. Referral to and engagement in OUD treatment within the OIC context requires ongoing efforts to bridge the treatment and court systems, and reduce stigma around MOUD.

Technology Access and Perceptions of Telehealth Services Among Young Adults Involved in the Court System.

PURPOSE: This study examined access to technology and telehealth among young adults (ages 18-24) who were court-involved and were recruited from an alternative sentencing program in New York City. METHODS: Using sequential mixed methods design, we examined demographic factors linked with access to technology and perceived usefulness of the Internet among n = 321 young adults who were court-involved (75% male, 65% African American, 35% Latinx). We then conducted in-depth interviews with 27 young adults to elicit first-person account of their access to, interest in, and experience with technology and telehealth. RESULTS: Although most participants had access to a phone with a data plan, a substantial proportion reported inconsistent access to the technology critical to telehealth. Certain young adults were more likely to lack consistent access to the technology needed for telehealth, including Black young adults, males, those with less than a high school diploma, those with a history of homelessness, and those who had difficulties paying for basic necessities. Qualitative interviews revealed that most had a strong self-efficacy using technology, while distrust of technology, inexperience with and skepticism of telehealth, low perceived need for care, and medical mistrust were common significant barriers in this underserved population. DISCUSSION: Findings underscored the critical need to address medical mistrust and increase access to and utilization of care among young adults who are court-involved. Results can inform the development and implementation of interventions designed to improve accessibility and acceptability of telehealth.

Patterns and contexts of polysubstance use among young and older adults who are involved in the criminal legal system and use opioids: A mixed methods study.

INTRODUCTION: Opioid prevention and treatment programs tailored to young adults involved in the criminal legal system are rare. We examined profiles of polysubstance use among younger and older adults involved in the criminal legal system who use opioids, and explored their experiences and motivations related to substance use. Information gleaned can inform the adaptation of existing programs and the development of novel approaches for young adults in the criminal legal system. METHODS: Using a sequential mixed methods design we 1) quantitatively identified typologies of polysubstance users among adults aged 18-24 (n = 92) and those age 25 and over (n = 27) involved in the criminal legal system who use opioids, using latent class analysis and 2) qualitatively explored differences in personal motivations, cultural influences, and psychosocial contexts of substance use by class. RESULTS: Our quantitative results supported a three-class typology: the majority of participants were in Class I (73 %, n = 87) and reported using primarily alcohol and marijuana. Participants in Classes II (15 %, n = 18) and III (12 %, n = 14) endorsed distinct and complicated polysubstance use profiles. Further, participants in Classes I and III were significantly younger than those in Class II. Qualitative analysis allowed us to understand associations between patterns of use, motivations, and contexts among young and older adults, comparing across classes. CONCLUSIONS: Our results highlight the importance of attending to the needs of subpopulations based on age and use patterns to adapt and develop targeted treatment and prevention programs for high-risk adults involved in the criminal legal system.

Readiness to change among justice-involved young adults in an alternative sentencing program who screened positive for alcohol or drug risk.

Introduction: Readiness to change is a key component of substance use behavioral change; yet little is known about readiness to change among justice-involved young adults. This study 1) describes readiness to change alcohol and drug use and 2) examines predictors of readiness to change alcohol and drug use among justice-involved young adults. Method: Justice-involved young adults (18-24 years; n = 137) who were positive on a validated alcohol and/or drug screening tool completed an interview assessing substance use, readiness to change, and reasons to quit. A multivariable linear regression model examined whether reasons to change and substance use severity, and interactions between these, predicted readiness. Results: More than half of participants were contemplating or had decided to quit/cut down substance use. Personal reasons to quit were positively related to readiness to change; interpersonal reasons were negatively associated. Conclusions: This study contributes information needed to design motivational interventions for substance use among justice-involved young adults. Personal reasons to quit using drugs are a potential intervention target.

Implementing an STI screening initiative in New York City community colleges.

Objectives: Nationally, community colleges provide academic instruction to 5.6 million students annually. However, sexual health services, are often lacking. This pilot study was developed to assess the feasibility of implementing screening for sexually transmitted infections in community college settings in New York City where approximately 86,075 students attend classes. Methods: We recruited and trained an interdisciplinary group of graduate students (public health, nursing, and post-baccalaureate/pre-med) to provide sexual health risk assessments, screening for sexually transmitted infections, and linkages to care at three community college campuses in New York City. Results: Over a three-year period (2017-2019), 545 students were screened for STIs and 7.2% were positive for Chlamydia. Conclusions: Community college students are at high risk for sexually transmitted infections yet have limited access to sexual health services. Coordinated partnerships between state and local departments of health, public health schools, and an academic medical center demonstrate an important model which can fill identified gaps for this vulnerable population.

Stepped-wedge randomized controlled trial of a novel opioid court to improve identification of need and linkage to medications for opioid use disorder treatment for court-involved adults.

In response to the opioid crisis in New York State (NYS), the Unified Court System developed a new treatment court model-the opioid intervention court-designed around 10 Essential Elements of practice to address the flaws of existing drug courts in handling those with opioid addiction via broader inclusion criteria, rapid screening, and linkage to medications to treat opioid use disorder (MOUD). The new court model is now being rolled out statewide yet, given the innovation of the opioid court, the exact barriers to implementation in different counties with a range of resources are largely unknown. We describe a study protocol for the development and efficacy-test of a new implementation intervention (Opioid Court REACH; Research on Evidence-Based Approaches to Court Health) that will allow the opioid court, as framed by the 10 Essential Elements, to be scaled-up across 10 counties in NYS. Using a cluster-randomized stepped-wedge type-2 hybrid effectiveness-implementation design, we will test: (a) the implementation impact of Opioid Court REACH in improving implementation outcomes along the opioid cascade of care (screening, referral, treatment enrollment, MOUD initiation), and (b) the clinical and cost effectiveness of Opioid Court REACH in improving public health (treatment retention/court graduation) and public safety (recidivism) outcomes. Opioid Court REACH has the potential to improve management of individuals with opioid addiction in the court system via widespread scale-up of the opioid court model across the U.S., should this study find it to be effective.

At-Home Testing for Sexually Transmitted Infections During the COVID-19 Pandemic.

During the COVID-19 pandemic in New York City, NewYork-Presbyterian Hospital provided HIV prevention patients with gonorrhea/chlamydia testing kits at home. This report describes the program implementation to provide other sexual health clinics with a roadmap in adapting to a "new normal" in providing comprehensive sexual health care virtually to patients.

A study protocol for a randomized controlled trial of a cross-systems service delivery model to improve identification and care for HIV, STIs and substance use among justice-involved young adults.

BACKGROUND: Justice-involved young adults (JIYA) aged 18-24 are at significant risk for HIV and problematic substance use (SU) but are unlikely to know their HIV status or be linked to HIV or SU treatment and care. Intensive efforts to increase screening and improve linkage to HIV and SU services for JIYA are needed that address youth as well as justice and health/behavioral health system-level barriers. METHODS: MoveUp is a four-session intervention that integrates evidence-based protocols to promote HIV and STI testing, HIV and SU behavioral risk reduction and engagement in treatment for JIYA. MoveUp is delivered onsite at an alternative sentencing program (ASP) by HIV testing outreach workers from a youth-focused medical and HIV treatment program. N = 450 youth are randomized following baseline assessment into two groups: MoveUp or standard of care. Youth are followed for 12 months following the intervention; unprotected sexual behavior, substance use, HIV and STI testing as well as treatment linkage will be assessed at 3, 6, 9 and 12-months. DISCUSSION: This study is one of the first to systematically test an integrated screen/testing, prevention intervention and linkage-to-care services program (MoveUp), using evidence-based approaches to address the overlapping HIV/STI and substance use epidemics in JIYA by providing on-site services to identify HIV/STI and SU risk and treatment need within justice-settings as well as linkage to services in the community. This approach, capitalizing on health and justice partnerships, represents an innovation that can capitalize on missed opportunities for engaging JIYA in health care.

Overheard in the halls: what adolescents are saying, and what teachers are hearing, about health issues.

BACKGROUND: Schools have long been recognized as an excellent place to offer health education and supportive services. Teachers are among the most important influences in the lives of school-aged children and can provide valuable insight into the health issues important to adolescents. The purpose of this study was to examine the potential role general academic teachers may play in facilitating adolescent health promotion efforts. METHODS: To determine what teachers think about the role of health promotion in schools and what tools and topics they would find most helpful as critical advisers to students, we administered a 28-question survey at staff development meetings in 4 New York City schools. RESULTS: Teachers agreed that schools were an important venue for discussing and providing health messages. More than half of those surveyed reported having overheard student discussions about health once a week or more, and 70% stated that they had been actively approached by students 1-3 or more times per semester with reports of personal problems or health issues. Teachers expressed concern about their ability to handle student mental, behavioral, and reproductive health problems and desired additional staff development workshops to address these needs. CONCLUSIONS: Teachers felt that schools were important places to promote dialogue about health and accept the importance of playing a broader role in the lives of youth beyond education. To enhance the prospect of health-promoting interactions between teachers and students, attention must be paid to developing the overall skill and comfort level of teachers with respect to adolescent health concerns.

A community-based intervention designed to increase preventive health care seeking among adolescents: the Gonorrhea Community Action Project.

OBJECTIVES: We evaluated the effectiveness of an intervention designed to increase preventive health care seeking among adolescents. METHODS: Adolescents and young adults aged 12 to 21 years, recruited from community-based organizations in 2 different communities, were randomized into either a 3-session intervention or a control condition. We estimated outcomes from 3-month follow-up data using logistic and ordinary least squares regression. RESULTS: Female intervention participants were significantly more likely than female control participants to have scheduled a health care appointment (odds ratio [OR]=3.04), undergone a checkup (OR=2.87), and discussed with friends or family members the importance of undergoing a checkup (OR=4.5). There were no differences between male intervention and male control participants in terms of outcomes. CONCLUSIONS: This theory-driven, community-based group intervention significantly increased preventive health care seeking among female adolescents. Further research is needed, however, to identify interventions that will produce successful outcomes among male adolescents.

More than heights and weights: what parents of urban adolescents want from health care providers.

To examine health care providers' expected role in health promotion counseling to urban adolescents from the perspective of parents. Although participating parents wanted health care providers to counsel their adolescents on sensitive health issues, their desires and expectations were rarely met.

Parents of urban adolescents in Harlem, New York, and the Internet: a cross-sectional survey on preferred resources for health information.

BACKGROUND: Vulnerable populations suffer disproportionately from a variety of health conditions. Access to health information is an important component of health promotion. Reports suggest that while health providers and print media are traditional sources of information, the Internet may be becoming an increasingly important resource for consumers. Particularly, for parents of urban adolescents of color, the Internet could prove to be a valuable asset in helping them understand adolescent health and behavioral issues. OBJECTIVE: To determine the types of adolescent health and behavioral issues of concern to parents of color and to assess their preference for sources of health information, including the Internet. METHODS: A confidential, self-administered survey was administered to parents (largely of African American and Hispanic descent) of 9th-grade students over a 2-year period during 2001-2002 in Harlem, NY. The instrument assessed health and behavioral topics of concern, preferred resources for information, ownership and utilization patterns of computers and the Internet, and interest in obtaining additional computer/Internet training. RESULTS: A total of 419 surveys were completed; 165 in 2001 (67% response rate) and 254 in 2002 (no response rate available). Analysis of responses indicated a substantial degree of interest in obtaining information about a variety of adolescent health issues, including: HIV, sexually transmitted infections, , mental health concerns and relationships with family and peers. While home ownership of computers (84%) and access to the Internet were reasonably high (74%), use of the Internet for health information was low (14%). However, 62% of parents indicated a strong desire to have more instruction on computers and the Internet. CONCLUSIONS: Compared to other sources of health information, the Internet is underutilized by urban parents of color. Additional research is needed to identify strategies to improve utilization and assess subsequent impact on parenting activities.