Substance Related Disorders
Conditions
Keywords
opioid, child welfare, prevention, evidence-based, implementation, stimulants
Brief summary
This study will explore how to expand the Just Care for Families (JCFF) program beyond its current sites in Oregon, while addressing two main challenges: the developer team cannot provide ongoing support to every new program, and rural counties face limits on caseloads and reimbursement because of long travel distances. To overcome these barriers, the trial will test two strategies-using a JCFF mobile app to improve outcomes and efficiency, and relying on trained Experts (instead of the developer team) to guide new counties. With five active counties and four new ones, researchers will study whether parents receiving JCFF with digital support show reduced opioid and stimulant use, better child welfare outcomes like reunification, and more efficient treatment. This study will also compare how well new counties implement JCFF compared to existing ones, and use modeling to see if digital tools help programs sustain themselves by balancing caseloads and reimbursement. This study is supported by and included in the Helping to End Addiction Long-term Initiative (https://heal.nih.gov/).
Detailed description
This Hybrid Type II effectiveness-implementation trial uses an adaptation of a stepped-wedge design to test clinical outcomes spanning interception points within the Child Welfare system and implementation outcomes when Just Care for Families (JCFF) is delivered with the addition of a mobile App with provider feedback about parent App usage. Nine rural Oregon counties, five active counties previously implemented with developer support, and four new counties that will implement with new JCFF Expert support have been recruited to test the clinical effectiveness of JCFF when delivered with and without the App. A total of 254 parents with opioid and/or stimulant use and intersection with the Child Welfare system will be recruited to participate. Parents will receive usual services, JCFF, JCFF with the App, or JCFF with the App and feedback. Longitudinal in-person assessments at baseline, 4-months, 9-months, 14-months, and 18-months, and weekly text assessments of social determinants of health needs and Child Welfare intersection will test the reduction in parent opioid and stimulant use over time with increased treatment engagement, retention, completion and decreased length of Child Welfare case, reentry into treatment, and recidivism (arrest, Child Welfare re-referral). The effectiveness of the JCFF implementation approach will be tested when implemented with the support of new JCFF Experts versus developer Experts, with the aim of equal effectiveness. Clinical and implementation outcomes will be modeled to examine the impact that adding the App could have on program sustainment for rural programs, expanding the potential for JCFF to scale up in Oregon and elsewhere, positioning for public health impact. This study is supported by and included in the Helping to End Addiction Long-term Initiative (https://heal.nih.gov/).
Interventions
BEHAVIORALJust Care for Families (JCFF)
Just Care for Families is a behavioral intervention to address the needs of families involved in or at-risk for involvement with the child welfare system. Just Care involves treatment components, supported by ongoing purposeful engagement: (1) Substance use treatment including contingency management and positive reinforcement, day planning, healthy environments and peer choices, and refusal skills; (2) Mental health treatment including cognitive behavioral therapy, developing healthy coping skills, emotion regulation skills, exposure therapy, and referral for medication management; (3) Parent management training including parenting skills, nurturing and attachment, reinforcement, emotion regulation, supervision, structure, non-harsh discipline, and nutrition; (4) Community building including indigenous and external social supports; (5) Systems navigation; and (6) provision of assistance with basic needs including assistance with housing and employment.
BEHAVIORALJust Care for Families (JCFF) App
Participants will use a Just Care for Families digital support application (App). App features will include interactive tools modeled after those used for in-person interventions and practice exercises. Parent data will be stored within the App, including entered self-report and usage data.
BEHAVIORALJust Care for Families (JCFF) App Feedback
Coaches will receive feedback on parent's use of the App. Parent-reported current needs, clinical status (e.g., substance use and mental health symptoms), progress, and goals will be programmed into dashboards accessible to assigned Coaches (i.e., Feedback).
Sponsors
Chestnut Health Systems
National Institute on Drug Abuse (NIDA)
Study design
Allocation
RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Ongoing delivery of JCFF in active counties supports commencement of recruitment upon IRB approval in Year 1. Eligible parents in new counties will be recruited as a no-treatment Usual Services control in Year 1. In Year 2, both active and new clinics will be assigned to two groups, balanced by county social risk factors and child welfare outcomes, and "stepped" from their Year 1 condition to receive JCFF with the addition of the JCFF App (JCFF+ App), and then again, when FB is provided to Coaches (JCFF+App+FB). Parents will be assigned to one of four conditions: JCFF, JCFF + a digital App alone, JCFF + the App and intervention Coach feedback (FB) or usual services. Thus, intervention condition varies over time for counties, teams, and Coaches, but it is a single status for each parent.
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* Misuse of opioids and/or stimulants in the last year, including misuse of prescriptions * parent of a child aged 0-18 with the child living in the home or a reunification plan in place * residing in one of the nine participating counties * insured by Medicaid * access to a computer, smartphone, or wireless/cellular connection if a device were to be provided * Willing to enroll with the first available Just Care coach
Exclusion criteria
\-- Alcohol use disorder
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Opioid and/or Stimulant Use from Baseline to 18 months | Baseline, 4 months, 9 months, 14 months, and 18 months | Any opioid or stimulant use in the past 30 days as measured by the Addiction Severity Index. |
| Treatment Engagement | Up to 18 months | Number of sessions attended as reported by coaches in the Just Portal software used as part of the JCFF delivery and fidelity monitoring. |
| Treatment Retention | Up to 18 months | Retained in treatment through completion (i.e. mutual decision between client and coach for how to end treatment). Measured only for the first treatment episode. |
| Child Welfare Re-Report | Up to 18 months | Any new referrals for parent or child as reported in Oregon Department of Human Services Administrative Data. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Child Reunification | Up to 18 months | Any record of child being reunified with parent as reported in Oregon Department of Human Services Administrative Data. |
Countries
United States
Contacts
CONTACTRowan M McClelland-Bishop
CONTACTRyan R Sigh, PhD
PRINCIPAL_INVESTIGATORLisa Saldana, PhD
Chestnut Health Systems
Outcome results
None listed