ABSTRACT
Recognizing the current opioid crisis among justice-involved individuals and the need to intervene at the intersection of justice and community health, the JCOIN TCU hub study explores outcomes associated with a multi-level hybrid implementation approach. The study capitalizes on facilitated collaboration, training, and cross-system data sharing to leverage improvements in criminal justice (CJ) and community behavioral health (CBH) interagency collaboration. The goal is 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. The study compares two implementation strategies: one (vertical) in which all units in a community are trained and begin the program simultaneously and another (horizontal) in which one lead-off unit in the community is trained as a prototype of the program, the prototype is tested and refined, and then the lead-off unit helps to train other units within the community. Specific aims are to 1) increase access to and retention in CBH and medications for opioid use disorder services; 2) improve outcomes associated with public health and safety; 3) compare two implementation strategies on systems-level outcomes designed to increase service initiation and receipt of implementation and services; and 4) examine the impact of these strategies on justice-involved individuals' outcomes. The study examines both implementation and implementation-effectiveness, seeking to answer the questions of which implementation strategy is most effective for rapid and sustainable uptake of evidence-based practices and for increasing service linkage and initiation, services retention, and improved opioid-related public health safety outcomes. The study uses a hybrid type 3 study design. The study's primary aim is to compare two implementation strategies and two interventions at two levels (client and system), with a secondary aim to assess client-level outcomes associated with the trial. The study design integrates 2 robust methodologies (stepped wedge and cluster randomized trial), and plans to include 18 research performance sites (communities) located in Texas, New Mexico, and Illinois. The study will contribute to the JCOIN network's effort to establish a national consortium of investigators examining promising strategies to enhance the capabilities and capacity of the justice system to more effectively address the opioid epidemic.
