Justice Community Overdose Innovation Network II TCU Hub

Official title

Justice Community Overdose Innovation Network II TCU Hub: TCU Building Resilient Initiatives for Deflection Through Greater Engagement Project (TCU BRIDGE to Deflection Project)

Overview

The current study proposes to use a Hybrid Type 3 implementation research strategy to: 1) Significantly enhance our understanding of public health outcomes \[e.g., overdose incidents and substance-use (SU)-related Emergency Medical Service (EMS) contacts\] and public safety outcomes (e.g., drug-related arrests) associated with Deflection and Pre-Arrest Diversion initiatives (DPAD, hereafter referred to as Deflection); and 2) Create a lasting contribution to the fields of research focused on SU and the criminal legal system (CLS) by advancing knowledge of effective implementation strategies involving the critical role of community engagement in Deflection. The highly experienced team of Multiple PIs, senior-level collaborators from both Deflection and Community Behavioral Health (CBH), state-level evaluation partners, a national stakeholder advisory group, and CLS and behavioral health partners within each community have teamed up to carry out the proposed project. The study approach uses a hybrid implementation-effectiveness design to examine strategies to improve opioid and stimulant relevant outcomes, and specifically proposes to test the implementation-effectiveness of 2 strategy bundles to promote Deflection models through a CORE community engagement bundle (designed to facilitate community stakeholder engagement) and ENHANCED community engagement bundle (CORE plus a component to systematically involve community advocates) on improving implementation as well as public safety and health outcomes. The proposed randomized control trial includes a total of 20 geographically distinct clinical research performance sites (i.e., 20 communities spanning 5 states; New Mexico, Illinois, Wisconsin, Colorado, and Pennsylvania), with 3-5 communities per state and the inclusion of key CLS and CBH stakeholders within each site. The large scope of the project will maximize potential generalizability of study results and sustainability of implementation strategies.

Interventions

• Other Core-interagency community engagement approach
  community engagement approaches that including building interagency collaboration, strategic planning, advocacy
• Other Enhanced-Core plus community engagement specialist
  community engagement approaches that include the core, plus promoting identification and full integration of community citizens in community engagement practices

Primary outcome measures

• public health and safety collaboration [Time frame: Month 10, 26, and 38 for Wave1; Month 14, 30, and 42 forWave 2]
• citizen awareness and perceived utility of Deflection [Time frame: Month 10, 26, and 38 for Wave1; Month 14, 30, and 42 forWave 2]
• deflection workforce referrals and citizen enrollments in Deflection [Time frame: Month 10, 26, and 38 for Wave1; Month 14, 30, and 42 for Wave 2]
• overdose and SU related mortality [Time frame: Month 4-38 for Wave 1; Month8-42 for Wave 2]
• service access along the full substance use cascade [Time frame: Month 4-38 for Wave 1; Month8-42 for Wave 2]

Secondary outcome measures (2)

• deflection workforce attitudes toward deflection [Time frame: Month 10, 26, and 38 for Wave1; Month 14, 30, and 42 forWave 2]
• citizen ratings of community law enforcement trust [Time frame: Month 10, 26, and 38 for Wave1; Month 14, 30, and 42 forWave 2]

Eligibility criteria

Staff

Inclusion criteria

• Directly involved in Deflection services, including:
• Making referrals (e.g., law enforcement, first responders, community agencies) \& Providing services to participants (e.g., case managers, peer specialists, coordinators);
• Aged 18 years or older;
• Able to complete surveys in English;
• Willing to provide informed consent

Exclusion criteria

• Not affiliated with a participating Deflection agency;
• No role in Deflection referral or service delivery;
• Under age 18;
• Unable or unwilling to provide informed consent

Clients

Inclusion criteria

• Aged 18 years or older;
• Enrolled in a Deflection program within a participating community;
• Between 1 and 12 months post-enrollment at time of recruitment;
• Documented history of substance use disorder (SUD) or risk for SUD;
• Priority for individuals reporting opioid and/or stimulant use within the past year;
• Able to complete survey and/or interview; Willing to provide informed consent

Exclusion criteria

• Under age 18;
• Not enrolled in a Deflection program;
• Insufficient exposure to Deflection (<1 month);
• Unable or unwilling to provide informed consent

Citizens

Inclusion criteria

• Aged 18 years or older;
• Resident of a participating community;
• Represents general community population (including individuals with or without lived experience of SUD/CLS involvement);
• Able to participate in: Surveys and/or Community Listening Sessions;
• Willing to provide informed consent

Exclusion criteria

• Under age 18;
• Not residing in a participating community;
• Unable or unwilling to provide informed consent

Workgroup

Inclusion criteria

• Aged 18 years or older;
• Identified as a community or agency leader/stakeholder involved in Deflection programming;
• Member of a DAG within a participating community;
• Represents one of the required stakeholder roles: Law enforcement leadership or staff, Behavioral health leadership or staff Health professional, Community representative (citizen);
• Able to participate in meetings, surveys, and/or focus groups;
• Willing to provide informed consent

Exclusion criteria

• Not part of a DAG in a participating community;
• Does not hold a role relevant to Deflection leadership or decision-making;
• Under age 18;
• Unable or unwilling to provide informed consent

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Other

Study locations

United States · 1 center

• Texas Christian University — Fort Worth

Publications

• Yang, Y. and Knight, K., (2024). An AI-Driven Tool for Precisely Identifying Intervention Needs with Ecologically Valid, Multimodal Data (AI-PINNED). https://ibr.tcu.edu/ai-pinned/
• Wu E, Villani J, Davis A, Fareed N, Harris DR, Huerta TR, LaRochelle MR, Miller CC, Oga EA. Community dashboards to support data-informed decision-making in the HEALing communities study. Drug Alcohol Depend. 2020 Dec 1;217:108331. doi: 10.1016/j.drugalcdep.2020.108331. Epub 2020 Oct 1. PMID 33070058
• Winkelman TNA, Chang VW, Binswanger IA. Health, Polysubstance Use, and Criminal Justice Involvement Among Adults With Varying Levels of Opioid Use. JAMA Netw Open. 2018 Jul 6;1(3):e180558. doi: 10.1001/jamanetworkopen.2018.0558. PMID 30646016
• Wiese AL, Carey PD, Becan JE, Wood C, Knight K. Policy Changes to Improve Service Access: Best Practices for Researchers Engaging With Criminal Justice Partners. J Correct Health Care. 2025 Feb;31(1):11-16. doi: 10.1089/jchc.24.09.0075. Epub 2024 Nov 28. PMID 39607681
• Weiner BJ, Lewis CC, Stanick C, Powell BJ, Dorsey CN, Clary AS, Boynton MH, Halko H. Psychometric assessment of three newly developed implementation outcome measures. Implement Sci. 2017 Aug 29;12(1):108. doi: 10.1186/s13012-017-0635-3. PMID 28851459
• Walters ST, Drainoni ML, Oga EA, Byard J, Chandler RK. Solving the "last mile" problem in overdose prevention: Lessons from the HEALing Communities Study. Drug Alcohol Depend. 2024 Nov 1;264:112453. doi: 10.1016/j.drugalcdep.2024.112453. Epub 2024 Sep 28. PMID 39379270
• Tsui JI, Barry MP, Austin EJ, Sweek EW, Tung E, Hansen RN, Ninburg M, Scott JD, Glick SN, Williams EC. 'Treat my whole person, not just my condition': qualitative explorations of hepatitis C care delivery preferences among people who inject drugs. Addict Sci Clin Pract. 2021 Aug 12;16(1):52. doi: 10.1186/s13722-021-00260-8. PMID 34384494
• Tang F, Ishwaran H. Random Forest Missing Data Algorithms. Stat Anal Data Min. 2017 Dec;10(6):363-377. doi: 10.1002/sam.11348. Epub 2017 Jun 13. PMID 29403567

Identifiers

NCT: NCT07528846 · 1RM1DA064502 · 1RM1DA064502

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗