Using implementation interventions and peer recovery support to improve opioid treatment outcomes in community supervision: Protocol.

OBJECTIVE: The purpose is to determine whether a facilitated local change team (LCT) intervention improves linkage to medication for opioid use disorder (MOUD) and implementation outcomes, and whether participant-level outcomes are further enhanced by use of peer support specialists (PSS).
METHODS: This Type 1 hybrid implementation-effectiveness study involves a pre-post design (implementation study) followed by a randomized trial of PSS (effectiveness study). Participants are at least 114 justice and service staff from 7 sites in three states: probation officers, community treatment providers, a supervisor from each agency, and key stakeholders. The study will recruit up to 680 individuals on probation from seven adult community probation offices; eligible individuals will be recently committed, English speakers, with opioid use disorder (OUD). Core Implementation Study: The study will use the exploration, preparation, implementation, sustainability (EPIS) framework to guide system-change through facilitated LCTs of probation and community treatment staff given a core set of implementation strategies to set goals. The study will collect program-level and staff survey data at the end of each EPIS stage. Implementation outcomes: Organizational engagement in MOUD (primary), plus changes in staff knowledge/attitudes and organizational outcomes (secondary). Effectiveness Study of PSS: After completing implementation, the study will randomize adults on probation to receive PSS vs. treatment as usual, with assessments at baseline, 3, 6 and 12 months. Effectiveness outcomes include participant engagement in MOUD (primary), probation revocation, illicit opioid use, and overdoses. Other aims include identifying barriers and facilitators, and cost-benefit analysis of PSS. Adaptations in response to COVID-19 included moving many procedures to remote methods.