PIERS STUDY

Providing Interventions to Enhance Recovery in Community Supervision (PIERS)

A JCOIN Initiative

Background

Opioid use disorder and associated overdose deaths have risen at an alarming rate in recent years and in 2017 exceeded all other years in recorded history. More than 50% of incarcerated individuals have a history of substance use and over 200,000 individuals with opioid dependence pass through the US criminal justice system annually. Individuals who have been previously incarcerated have a significantly higher risk of dying from overdose; particularly in the first two weeks after release, when individuals are at a higher risk of an unintentional fatal overdose. Of the approximately 1 in 55 adults under community supervision, nearly half have a substance use disorder (SUD). Although rates of SUD are high, there is limited access to appropriate treatment while on community supervision with only 18-26% receiving it. This is despite evidence that providing medication for opioid use disorder (MOUD) to individuals on probation or parole significantly decreases the rate of relapse and recidivism, and increases retention in substance abuse treatment. In 2016, RIDOC introduced the first correctional system-wide MOUD program in the country to initiate a comprehensive program to offer all three FDA approved medications (in all prison or jail settings) to all eligible individuals. As a result of the RIDOC program, we have expanded MOUD with linkage to treatment in the community that is associated with a significant drop in statewide overdose deaths post-release. Despite the comprehensive services offered, only 33% of those individuals who were new on MOUD followed up with treatment post-release. Therefore, there is still a need to improve MOUD linkages and engagement for those under community supervision.

Objective

Individuals who have been previously incarcerated have a significantly higher risk of dying from overdose; particularly in the first two weeks after release. More than 4.5 million people is the US are supervised in the community setting and nearly half have a substance use disorder, but few receive services. There is a critical need for linkage to MOUD for individuals on community supervision. Providing MOUD to individuals on probation or parole decreases the rate of relapse and recidivism, and increases retention in substance abuse treatment. In 2016, RIDOC introduced the first correctional system-wide MOUD program in the country to initiate a comprehensive program to offer all three FDA approved medications (in all prison or jail settings) to all eligible individuals. As a result of the RIDOC program, MOUD linkage to treatment in the community that is associated with a significant drop in statewide overdose deaths post-release has expanded. This work is the foundation from which the current proposal is built. The research is to rigorously test a systems-change approach for increasing use of MOUD using a randomized type 1 hybrid implementation-effectiveness design in probation and parole sites. The project proposes a unique network of 7 geographically distinct community supervision (probation and parole) performance sites from Rhode Island, North Carolina, and Pennsylvania. After a 6-month period of baseline for comparison, the Exploration, Preparation, Implementation, Sustainability framework is used to guide systems-change through facilitated local change teams consisting of justice and community service providers. A core set of implementation strategies is provided to all sites. The overall objective is to improve linkage to the continuum of evidence-based care for justice-involved individuals. Organizational assessments are timed with EPIS stages. At the end of Implementation, N=680 probation/parolee clients will be randomly assigned to receive peer support specialists vs. no peer support with follow-up at 3, 6 and 12 months. Implementation outcomes include program acceptability, adoption, penetration, sustainability and costs. Client-level effectiveness outcomes include retention, satisfaction, opioid use, opioid overdoses, recidivism, linkage to OUD treatment, and utilization of recovery services. This research team is uniquely poised to evaluate the implementation and impact of MOUD among justice-involved individuals, to answer questions of urgent public health significance, inform implementation science, and improve service delivery.

Outcomes

Aim 1 is to test the effectiveness of probation/parole peer support specialist condition compared to treatment as usual on client outcomes. Outcomes to measure will be: engagement in MOUD (primary), re-arrest (secondary), illicit opioid use (secondary), and fatal and non-fatal overdose (tertiary).

Aim 2 is to test the effectiveness of the EPIS Core Implementation Intervention relative to baseline on client outcomes. Outcomes to measure will be: engagement in MOUD (primary), re-arrest (secondary), illicit opioid use (secondary), and fatal and non-fatal overdose (tertiary).

Aim 3 is to test the effectiveness of the EPIS Core Implementation Intervention, relative to baseline in terms of organizational and staff level outcomes. Outcomes to measure will be: staff MOUD knowledge and attitudes, commitment and efficacy, and readiness for change; organizational readiness for change, commitment and efficacy; and penetration, adoption, and sustainability.

Aim 4 is to determine the societal cost implications of implementing a peer specialist model compared to treatment as usual using the Second Panel on Cost-Effectiveness in Health and Medicine cost-benefit analysis framework to inform policy decisions.

Aim 5 is to identify organizational and staff barriers and facilitators to intervention implementation by conducting semi-structured interviews with key stakeholders who are managing and delivering the MOUD program. This research is uniquely poised to evaluate the implementation and impact of MOUD among justice-involved individuals, to answer questions of urgent public health significance, inform implementation science, and improve service delivery.

Study Team/Roles

Rosemarie Martin, PhD, Assistant Professor (Brown), PI
Damaris Rohsenow, PhD, Research Professor (Brown), PI
Lauren Brinkley-Rubinstein, PhD, Assistant Professor (UNC-CH), PI
Jennifer Clarke, MD, MPH, Associate Professor (Brown), Co-Investigator
Theresa Shireman, PhD, Professor (Brown), Co-Investigator
Shayna Bassett, PhD, Assistant Professor (University of Rhode Island), Co-Investigator
Steven Belenko, PhD, Professor (Temple), Co-Investigator
Heidi Grunwald, PhD, Director (Temple), Co-Investigator
Linda Hurley, MA, CAGS, LCDCS, President/CEO (CODAC), Co-Investigator
Shabbar Ranapurwala, PhD, Assistant Professor (UNC-CH), Co-Investigator
Josiah Rich, Professor, MD, MPH, (Miriam Hospital), Co-Investigator
Gerald Stahler, PhD, Professor (Temple), Co-Investigator
Lyn Stein, PhD, Associate Professor (University of Rhode Island), Co-Investigator