Building Social and Structural Connections for the Prevention of Opioid Use Disorder Among Youth Experiencing Homelessness

Conditions

• Dual Diagnosis
• Homelessness
• Housing Problems
• Mental Disorder in Adolescence
• Opioid Use Disorder
• Risk Behavior

Eligibility Criteria

Sex

ALL

Age

14 Years - 24 Years

Healthy Volunteers

Not accepted

Interventions

• Motivational Interviewing/Community Reinforcement Approach (MI/CRA) — BEHAVIORAL
  MI/CRA includes two Motivational Interviewing sessions and twelve 1-hour Community Reinforcement Approach sessions.
• Strengths-Based Outreach and Advocacy (SBOA ) — BEHAVIORAL
  The number of Strengths-Based Outreach and Advocacy sessions participants will receive are flexibly determined based upon youth needs.
• Services as Usual (SAU) — BEHAVIORAL
  Participants assigned to this group will receive the standard services provided to all youth involved with the drop-in center.

Study Details

Homelessness severely affects health and well-being and is particularly negative for youth. Between 70-95% of youth experiencing homelessness (YEH) report problem substance use and 66-89% have a mental health disorder. Youth appear to be at greater risk for living on the streets or being homeless than adults and are more vulnerable to long term consequences of homelessness. Multiple social determinants of health (SDOH) are uniquely associated with homelessness, driving substance use and adverse mental health consequences. However, limited research has identified pragmatic interventions that have a long-term ameliorating impact on the complex, multi-symptomatic issues among these youth. This study overcomes prior gaps in research through testing a multi-component comprehensive prevention intervention targeting SDOH that may affect biopsychosocial health indicators and longer-term health outcomes. In partnership with a drop-in center for YEH, youth between the ages of 14 to 24 years, will be engaged and randomly assigned to conditions using a dismantling design so that essential intervention components can be efficiently identified. In particular, youth (N = 300) will be randomly assigned to a) Motivational Interviewing/Community Reinforcement Approach + Services as Usual (MI/CRA + SAU, n = 80), b) Strengths-Based Outreach and Advocacy + Services As Usual (SBOA + SAU, n = 80), c) MI/CRA + SBOA + SAU (n = 80) or d) SAU (n=60) through the drop-in center. In order to assess the longer-term prevention effects on substance use, mental health and other outcomes, all youth will be assessed at baseline and at 3, 6, 12, 18 and 24-months post-baseline. The primary goal of this study is to establish the impact of a comprehensive intervention embedded within a system that serves YEH, a community drop-in center, on youth's opioid misuse and disorder, other substance misuse and disorders, mental health diagnoses, and other targeted outcomes. This study will offer unique information on the physiological and psychological stress pathways underlying change for specific subgroups of youth along with cost estimates to inform future implementation efforts in drop-in centers around the country.

Key Dates

Start date

May 6, 2024

Status verified

Sep 2025

Primary completion

Dec 1, 2028

Completion

Dec 1, 2029

Study Design

Enrollment

300 participants (estimated)

Allocation

RANDOMIZED

Intervention model

PARALLEL

Primary purpose

TREATMENT

Arms

• Experimental: Motivational Interviewing/Community Reinforcement Approach + Services as Usual (MI/CRA + SAU)
  The current evidence base recommends integrating treatments targeting both Substance Use Disorder and psychiatric disorders, especially combining Motivational Interviewing with behavioral interventions such as CRA or Cognitive Behaviorial Therapy. Enhancing intrinsic motivation for behavioral change is the central purpose of motivational interviewing (MI), a clinical method built on the insights and strategies described by Carl Rogers as client-centered therapy. MI is also directive, however, in selectively eliciting and reinforcing client "change talk". Typically offered as a brief intervention of 1-2 sessions, MI has a strong record of efficacy in the treatment of alcohol and other drug use disorders, mental health and other problematic behaviors. The Community Reinforcement Approach (CRA) offers an empirically-based multifaceted approach to substance abuse/mental health treatment that also addresses many of the clinical needs of multi-problem homeless individuals.
• Experimental: Strengths-Based Outreach and Advocacy + Services As Usual (SBOA +SAU)
  Some research suggests that engagement with an advocate is key to success when linking those experiencing homelessness to available services and supports in the community. The strengths model is based on the premise that the purpose of advocacy "is to assist consumers in identifying, securing, and preserving the range of resources, both external and internal, needed to live in a normal, independent way in the community". Strengths-based interventions focus on enhancing well-being and happiness rather than attempting to correct deficits or pathology. The advocate takes responsibility for securing needed services for the youth and remains a support as they traverse the system of care. The focus of the first several weeks of advocacy is on obtaining identification and ensuring basic needs are met (food, safety, medical care, housing, etc.). As basic needs are addressed, youth and advocates focus on other high need areas including education, employment, mental health and substance use.
• Experimental: Motivational Interviewing/Community Reinforcement Approach (MI/CRA) + SBOA + SAU
  This intervention combines all three interventional models: Motivational Interviewing/Community Reinforcement Approach along with Strengths-Based Outreach and Advocacy and the Services as Usual.
• Active Comparator: Services as Usual (SAU)
  All youth will receive services as usual provided by the drop-in center.

Primary Outcome Measure

Form 90 Substance Use interview [ Time Frame: Administered at baseline, and 3-, 6-, and 12-, 18-, and 24-months post intervention. ]

Central Contacts

• Jodi Ford, PhD
  614-292-6862
  [email protected]
• Natasha Slesnick, PhD
  (614) 247-8469
  [email protected]

Locations (2)

Find similar trials in Columbus, OH

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