Examining Gender Differences in the Relationship Between School Bonding and Opioid Misuse Among Justice-Involved Adolescents.

Justice-involved adolescents (JIAs) have an increased risk for opioid use disorder and overdose related to opioid misuse (OM). Consequences of untreated OM include recidivism and poor educational outcomes, which can be harsher for female JIA. Therefore, identifying relevant factors and settings that reduce the risk for OM is critical. Schools are a central institution in adolescent development. Drawing on social control theory, JIA with higher levels of school bonding was hypothesized to attenuate risk for OM. Cross-sectional data on 79,960 JIA from the Florida Department of Juvenile Justice were examined. Multivariate and stratified logistic regression analyses were employed. On average, for every one-unit increase in school bonding, JIA had 22%, female JIA had 23%, and male JIA had 22% lower odds of OM. Results suggest school bonding and the school context should be considered in treatment and how this setting may impact OM intervention outcomes among JIA.

When a pandemic and epidemic collide: Lessons learned about how system barriers can interrupt implementation of addiction research.

Background: Telehealth technologies are now featured more prominently in addiction treatment services than prior to the COVID-19 pandemic, but system barriers should be carefully considered for the successful implementation of innovative remote solutions for medication management and recovery coaching support for people with opioid use disorder (OUD). Method: The Centers for Disease Control and Prevention funded a telehealth trial prior to the COVID-19 pandemic with a multi-institution team who attempted to implement an innovative protocol during the height of the pandemic in 2020 in Tampa, Florida. The study evaluated the effectiveness of a mobile device application, called MySafeRx, which integrated remote motivational recovery coaching with daily supervised dosing from secure pill dispensers via videoconference, on medication adherence during buprenorphine treatment. This paper provides a participant case example followed by a reflective evaluation of how the pandemic amplified both an existing research-to-practice gap and clinical system barriers during the implementation of telehealth clinical research intervention for patients with OUD. Findings: Implementation challenges arose from academic institutional requirements, boundaries and role identity, clinical staff burnout and lack of buy-in, rigid clinical protocols, and limited clinical resources, which hampered recruitment and intervention engagement. Conclusions: As the urgency for feasible and effective telehealth solutions continues to rise in response to the growing numbers of opioid-related deaths, the scientific community may use these lessons learned to re-envision the relationship between intervention implementation and the role of clinical research toward mitigating the opioid overdose epidemic.

The COVID-19 pandemic coupled with the opioid overdose epidemic has resulted in compounded challenges to the fields of addiction treatment and clinical research. This manuscript describes a CDC (Centers for Disease Control and Prevention)-funded randomized control trial that was initiated prior to the COVID-19 pandemic and implemented during the height of the pandemic through 2020 in Tampa, Florida. The study evaluated the effectiveness of a mobile device application, called MySafeRx, integrating remote recovery coaching with the option of daily supervised buprenorphine dosing from secure pill dispensers via videoconference to reduce barriers and enhance support for medication adherence during treatment. With the sudden emergence of COVID-19, this research, already challenged by a research-to-practice gap and existing clinical system barriers to medications for opioid use disorder (MOUD) treatment (e.g., siloed service delivery, stigmatized staff and community perceptions of buprenorphine, and high staff burnout/turnover), was amplified by the rapidly changing protocols for standards of care during the implementation of an OUD treatment research intervention in the midst of the start of the pandemic. Lessons learned related to challenges from academic institutional requirements, boundaries and role identity, burnout, staff buy-in, and clinical protocols and resources are discussed, and recommendations for future research are provided. As urgency for feasible and effective solutions continues to rise in response to the growing numbers of opioid-related deaths, the scientific community may use these lessons learned to re-envision the relationship between intervention implementation and the role of clinical research toward mitigating the opioid overdose epidemic.

Homegrown: Parent and Sibling Substance Abuse Linked to Opioid Misuse Among Justice-Involved Children.

Opioid misuse (OM) is a priority public health concern, especially for those in correctional settings. Understanding the etiology of OM among justice-involved children (JIC) is key to resolving this crisis. On average, 12% of all children and up to 50% of JIC in the United States have experienced household substance misuse (HSM). Theory and empirical research suggest that HSM may increase risk for OM, but these relationships have not been examined among JIC. The objective of this study was to examine the effects of sibling and parent substance misuse on OM among JIC. Cross-sectional data on 79,960 JIC from the Florida Department of Juvenile Justice (FLDJJ) were examined. Past 30-day opioid (P30D) OM was indicated by urine analysis. Bivariate and multivariate logistic regression analyses were employed. In the total sample, nearly 3% met FLDJJ criteria for P30D OM and nearly 25% lived with a parent/caregiver or sibling who misused substances. Among opioid misusers, one third lived with a parent/caregiver who misused substances and nearly half lived with a parent/caregiver or sibling who misused substances. Compared to JIC without HSM, JIC reporting sibling substance misuse had 1.95 times higher odds of OM (95% CI, 1.63-2.33), JIC with parent substance misuse had over twice the odds of OM (95% CI, 1.89-2.31), and those with both sibling and parent had more than three times higher odds of OM (95% CI, 2.75-3.87). Family-based approaches to OM intervention and prevention initiatives may be more effective than individual-focused approaches. Implications are discussed.

Racial/Ethnic Differences in the Effects of Adverse Childhood Experiences on Substance Misuse among Justice-Involved Children.

Background: Adverse childhood experiences (ACEs) are linked to substance use (SU) and substance use disorders (SUD). However, this relationship has yet to be tested among justice-involved children (JIC), and it is unclear if racial/ethnic differences exist. This study aimed to determine: (1) whether ACEs are associated with increased risk of SU and SUD among JIC; and (2) if the effects of ACEs on SU and SUD are moderated by race/ethnicity. Methods: Bivariate and multivariate logistic regression analyses were employed to examine a statewide dataset of 79,960 JIC from the Florida Department of Juvenile Justice. Marginal odds were estimated to examine how race moderates the relationship between ACEs and SU and SUD. Results: Results showed higher ACEs scores were linked to SU and SUD. Black JIC were 2.46 times more likely, and Latinx JIC were 1.40 times more likely to report SU than white JIC. Specifically, Black and Latinx JIC with a higher average ACEs score were more likely to report SU but less likely to have ever been diagnosed with a SUD when compared to white JIC with equivalent ACEs. Conclusions: Study results highlight the need to develop trauma-informed and culturally appropriate interventions for SU and SUD among JIC.

The nexus between gender, parental supervision, and opioid misuse among justice-involved adolescents.

Justice-involved adolescents (JIA) are at higher risk for opioid misuse (OM) and opioid-related overdose than nonoffending adolescents. Untreated OM can lead to severe consequences (e.g., trauma), which may be harsher for female JIA. Therefore, examining risk and protective factors, such as parental supervision, is essential to identify factors that may impact OM. The current study used a statewide, cross-sectional dataset including 79,960 JIA from the Florida Department of Juvenile Justice. Stratified logistic regression analyses were conducted. Results indicated that JIA who experienced sporadic or inadequate supervision had 2.14 and 3.54 higher odds, respectively, of misusing opioids compared to JIA who experienced consistent supervision. Female JIA who experienced sporadic or inadequate supervision had 2.23 and 3.70 higher odds, respectively, of misusing opioids. Results suggest parental supervision is an important protective factor that should be considered in developing prevention and treatment efforts that serve JIA who misuse opioids, especially females.

Sex differences in the association of adverse childhood experiences on past 30-day opioid misuse among Florida justice-involved children.

INTRODUCTION: Opioid misuse remains a chief public health concern in the United States, especially among justice-involved children and adolescents (JIC). Adverse childhood experiences (ACEs) are prevalent among JIC and are associated with a higher risk for opioid misuse. Justice involvement can be harsher for females, who tend to have higher ACE scores and experience more physiological and psychological risk factors than males. However, this study was the first to examine how sex may moderate the link between ACEs and opioid misuse. This study hypothesized that females will have higher odds of opioid misuse than males with equivalent ACEs. METHODS: The study team examined cross-sectional data on 79,960 JIC in the Florida Department of Juvenile Justice from 2007 to 2015. The study measured ACEs using 10 questions from the Positive Achievement Change Tool. Opioid misuse was reported by either self-disclosure, positive urinalysis, or other evidence of opioid consumption within the past 30 days. The team estimated logistic regression, marginal effects, and multiplicative interaction terms to test the hypotheses. RESULTS: JIC with an ACE score of 4 or higher were 2.59 times more likely to misuse opioids than JIC with lower ACE scores. Among JIC with 4 or more ACEs, females had significantly higher odds of opioid misuse than males. CONCLUSION: Reducing exposure to ACEs may decrease the risk for opioid misuse, particularly among females. These findings corroborate trauma-informed and sex-responsive prevention programs in the juvenile justice system.

Moving from Implementation Science to Implementation Practice: The Need to Solve Practical Problems to Improve Behavioral Health Services.

It is well recognized that the use of evidence-based practices (EBPs) is critical to improving service outcomes for those receiving behavioral health services. However, EBPs are not easily implemented in behavioral health settings, and there are many challenges to supporting these services over time. Recently, research efforts in implementation science (IS) have greatly expanded our understanding of issues that influence the successful implementation of EBPs. Unfortunately, less effort has been devoted to translating this research theory on a practical level to help individual service entities solve the specific problems of putting programs into place. A process is needed where service organizations and practitioners can build their capacity, informed by IS research, to improve service outcomes. The purpose of this commentary is to describe the IS research base, provide an introduction to implementation practice, describe challenges confronting practitioners, and propose necessary steps in building organizational capacity that enables practitioners to implement the most effective services available.

Exploring perceptions of implementation practice capacity in community-based behavioral health organizations.

Community-based organizations (CBOs) must have the capacity to adopt, implement, and sustain evidence-based practices (EBPs). However, limited research exists examining CBOs' ability/capacity to implement EBPs. The purpose of this preliminary study was to investigate how staff of CBOs perceive implementation practice capacity, determine factors needed for adequate capacity for implementing EBPs, and examine which perspectives of capacity are shared across organizational levels. Ninety-seven administrators and practitioners of CBOs were surveyed using the Implementation Capacity Survey, which examines perceived importance, presence, and organizational capacity of the CBO in nine implementation practice areas (IPAs) (e.g., leadership). Results revealed participants rated IPAs on the importance scale higher than IPAs on the present scale. Presence and organizational capacity scales were strongly correlated, and results showed significant differences between administrators and practitioners on ratings of presence and organizational capacity. Implications for future research aimed at examining/building implementation practice capacity in community settings will be discussed.

Evaluating an Implementation Science Training Program: Impact on Professional Research and Practice.

Real-world application and implementation of evidence-based practice continue to be a challenge across multiple sectors, including behavioral health settings. Providing the opportunity for future researchers and practitioners to gain capacity and knowledge through structured experiential learning in implementation science is critical to closing the research to practice gap. The Institute for Translational Research Education in Adolescent Drug Abuse (ITRE) is a graduate certificate program that offers specific coursework, a large-scale service-learning project based in the community, and mentorship related to implementation science research and practice. The purpose of this evaluation was to examine, from the perspective of ITRE scholars, the perceived impact on the development of professional research and practice skills once graduated from the ITRE program. Fifty-eight semi-structured interviews across five cohorts were selected randomly for in-depth thematic analysis (n = 58). Results suggest that the ITRE provides a unique approach grounded in implementation science for building robust and transferable skills for future researchers and practitioners working in a variety of behavioral healthcare settings.