NCIPC - National Center for Injury Prevention and Control Grants

NCIPC - National Center for Injury Prevention and Control

PROJECT SUMMARY/ABSTRACT People involved in the criminal legal system (CLS) face a disproportionately high burden of substance and opioid use disorders (SUD/OUD), which upon release from jail or prison is compounded by lack of access to care and results in extremely elevated post-release drug overdose mortality. Few interventions have been able to reduce overdose risk among CLS-involved people. A number of ongoing studies are testing strategies for linking CLS-involved people to medications for OUD (MOUD) in the community. However, lack of insurance for many CLS-involved people makes these care linkages unsustainable after study completion. Medicaid expansion provides an avenue to address healthcare needs for many CLS-involved people. Recent studies show that pre-release Medicaid enrollment increases post-release MOUD and reduces overdoses for CLS-involved people. However, benefits appear to accrue to white individuals and not to black individuals – a concerning inequity because overdose deaths are rapidly increasing among racially minoritized people in the US. Research to date, which has been ecological, has not been able to identify the mechanisms by which Medicaid enrollment may improve MOUD and overdose outcomes and why these benefits may differ across racialized groups. Large, longitudinal, individual level data can map the pathways through which Medicaid expansion benefits some groups but not others. While overdose prevention work among CLS-involved people deservedly focuses on MOUD access, the role of mental health treatment is also critical. Two-thirds of people with OUD have co-occurring mental health needs, a burden that is likely even higher among CLS-involved individuals. Hence, MOUD without mental health care may fall short in MOUD engagement and overdose prevention for CLS-involved individuals. In this application, we propose to conduct a quasi-experimental study, by leveraging the 2023 Medicaid expansion in North Carolina (NC), to examine racialized inequities in enrollment in Medicaid among CLS- involved individuals, as well as post-release MOUD and mental health care access. We will further examine the impact of enrollment in Medicaid and MOUD and mental health care access on fatal and non-fatal drug and opioid overdoses. We will use 13 years of Big Data (2013-2025) on all formerly incarcerated people in NC linked with Medicaid and death records, which our team already has access to through two ongoing studies focused on suicide and polydrug overdose prevention. Our study is aligned with RFA-CE-25-149’s Funding Option A. This study will be the first to examine the individual-level impact of Medicaid enrollment, MOUD access, and mental health services on drug and opioid overdoses among CLS-involved people. This study will further identify mechanistic factors that contribute to racialized inequities among CLS-involved people to help enhance and sustain linkage to care for all CLS-involved people, but especially racially minoritized individuals, thereby enhancing the impact of Medicaid expansion for all people.

NCIPC - National Center for Injury Prevention and Control

The Family Violence Prevention and Services Act (FVPSA)-funded Promising Futures initiative strengthens organizational capacity among community agencies to support families impacted by intimate partner violence (IPV). This proposed study will evaluate the impact of adding training and technical assistance (TTA) in healing- centered systems integration (All In For Kids model, AIFK) on reducing child abuse and neglect (CAN), IPV, and parental mental health conditions. This proposal responds to the call for rigorous evaluation of community- level primary prevention approaches to prevent adverse childhood experiences (RFA-CE-25-025), specifically, existing primary prevention approaches that address community-level conditions and strengthen economic supports to families (Research Objective 3). Since 2016, Promising Futures, a project of Futures Without Violence (FUTURES, national non-profit violence prevention organization), has provided support to a network of IPV state coalitions, local community-based programs, and other child-serving systems on enhancing services for families impacted by IPV. Opportunity to drive systemic change is hampered by siloing of systems, few incentives for cross-sector collaboration, limited involvement of community members in designing solutions, and challenges in collating and using shared data and metrics to monitor progress. To address these challenges, All In For Kids (AIFK), also a project of FUTURES, focuses on healing-centered systems integration to design responsive healing and caring early childhood ecosystems across health, education, and community sectors. AIFK promotes systems-level changes to sustain services, policies, and practices that result in holistic well-being across generations including strengthening economic supports to families. The proposed study will evaluate addition of AIFK healing-centered systems-transformation TTA with existing Promising Futures sites as a primary prevention approach to prevent ACEs. The research team has expertise in cross-sector collaboration, implementation science, community-partnered evaluation, healing-centered engagement, and science of thriving. This team will lead evaluation of the effectiveness of adding systems integration training via the AIFK model with Promising Futures grantees compared to matched grantees receiving usual support on CAN, IPV, parent mental health conditions, child thriving, and connectivity of early childhood ecosystems (Aim 1). The team will document implementation processes using qualitative and quantitative methods (Aim 2). With site leads and community partners, the team will disseminate lessons learned about use of community-led systems design to envision ideal structures, implement cross-sector solutions with measurable results, and improve prevention of ACEs (Aim 3).

NCIPC - National Center for Injury Prevention and Control

PROJECT SUMMARY Family violence, including child maltreatment and intimate partner violence, is a common and costly public health problem with long-lasting impacts on victims. Infants experience the highest rates of child maltreatment, and the risk of intimate partner violence has been shown to increase in the period after the birth of a child. Yet, few family violence prevention policies target this critical period. In response to RFA-CE-25-029, this Mentored Research Scientist Development Award (K01) Application proposes to leverage novel data linkages to study the relationship between the implementation of a state paid family leave policy and family violence. Specifically, the proposed study will pursue the following aims: 1) evaluate the completeness of a novel multi- year data linkage developed for the purposes of this study using records supplied by the Colorado Department of Labor and Employment (state paid family leave records), the Colorado Department of Public Health and Environment (vital birth and death records), and Colorado Department of Human Services (child protection records); 2) estimate factors that predict the use of state paid family leave, leveraging linked data at the person level; and 3) estimate the causal effect of state paid family leave on family violence indicators during infancy using a county-level difference-in-differences research design. Together, these aims will inform state and federal conversations about paid family leave and assist agencies in the upstream prevention of violence. The proposed research study addresses two research priorities of the CDC National Center for Injury Prevention and Control—specifically, the evaluation of (1) economic supports to families to prevent maltreatment, and (2) promising IPV prevention strategies. The PI aims to obtain formal training in causal effects study design while expanding her expertise to encompass more forms of cross-cutting violence. The PI will work with an interdisciplinary team of mentors who are internationally recognized experts in family violence prevention, causal inference, and the linkage and analysis of population-based, administrative records. The research and training proposed will provide the PI with the foundation she needs to become a future leader in the field of violence prevention whose research findings contribute to policy development on a national and global scale. The results of this study will support an R01 proposal to evaluate the synergistic effects of numerous policies that support and economically strengthen families to prevent cross-cutting violence, a CDC Injury Center research priority.

NCIPC - National Center for Injury Prevention and Control

This K01 award application is for Dr. Lindsey Palmer, a PhD-trained social worker whose overarching career goal is to become an independent violence prevention scientist, focused on promoting child health and well- being by advancing data-driven, evidence-based strategies to prevent maltreatment and its long-term consequences. This K01 will support three key areas of career development: 1) the application of machine learning approaches on violence prevention research, 2) cross-cutting violence prevention strategies, and 3) professional development and leadership. Dr. Palmer has assembled an interdisciplinary mentoring team comprised of Kristine Campbell, MD, MSc, a nationally recognized expert in pediatric child maltreatment with extensive experience collaborating with public agencies to develop cross-system prevention efforts; Fernando Wilson, PhD, an expert in the application of machine learning techniques on large-scale databases to examine health services and policy; Brooks Keeshin, MD, an internationally recognized expert in trauma assessment and suicide prevention; and Angela Fagerlin, PhD an expert in faculty enhancement, leadership and representation. Over the past decade, rates of self-directed violence (SDV) have risen sharply, particularly among 10- to 17-year-olds, with children and adolescents who have experienced maltreatment being at particularly heightened risk. A staggering 57% of children and adolescents who die by SDV have a history of alleged child maltreatment, which encompasses physical abuse, sexual abuse, emotional abuse, physical neglect, and exposure to intimate partner violence. These youths often face the compounded challenges of trauma, family dysfunction, and mental health issues. While child welfare system (CWS) involvement frequently signals heightened vulnerability, the pathways linking child maltreatment to SDV remain poorly understood. Contributing factors such as parental mental illness, substance use, overlapping forms of maltreatment, family instability are not well defined or understood. Additionally, there is limited evidence on the effectiveness of CWS interventions in reducing the risk of SDV for these children. This study’s Specific Aims include: 1) Determine the relationship between child maltreatment and SDV, specifically: Establish how the timing, type, and frequency of child maltreatment indicators are associated with SDV; and characterize the association between child maltreatment intervention and SDV; and 2) Leverage machine learning based approaches to identify direct and indirect pathways between child maltreatment and SDV, focusing on the progression of suicidal thoughts and behaviors over time. This study is significant and innovative because it will clarify the relationship between child maltreatment and SDV, identify high-risk subgroups, and examine if existing CWS interventions mitigate or exacerbate SDV risk, providing critical insights into the strengths and limitations of current maltreatment practices in reducing other forms of violence.

NCIPC - National Center for Injury Prevention and Control

Abstract The proposed project aims to test the short- and long-term effects of a hospital-initiated, community-integrated intervention and examine how social contexts influence its adoption and sustained effects. This study will be conducted in collaboration with the Spirit of Charity Trauma Center to implement a hospital-initiated motivational interviewing (MI) approach augmented by firearm safety training (FST) and monthly case management. We will employ a randomized control trial, to test the efficacy of the prevention approach (MI/FST) compared to treatment as usual (TAU) control condition. The scientific premise is that the intervention will be more effective in changing firearm-related behaviors and beliefs than the control at 6-months while meeting the needs of victims of violent injury. Firearm violence disproportionately occurs in black communities and hospitalized victims of firearm injury are at increased risk for violent injury reoccurrence. This calls for community-integrated, evidence-based approaches that identify critical barriers to prevention, including the need to test the effectiveness of hospital- initiated violent injury prevent program (HVIP) and examine how social contexts influence HVIP adoption and sustained effects. This proposal is quite feasible to complete because it leverages our ongoing community- integrated youth HVIP through our Violence Prevention Institute, including a CDC-supported Youth Violence Prevention Research Center (U01CE003384), currently being conducted in youth aged 18-24 in New Orleans. Our aims are to 1) establish the effects (at 6 months) of an expanded hospital-initiated, community-integrated intervention on firearm related behaviors and beliefs amongst adults ages 16-34, 2) to establish the effects (at 6-months) of the MI/FST intervention on meeting the needs of traumatically injured victims of violence that allow them to avoid violent injury recurrence, and 3) to understand and analyze stakeholders’ perspectives and experiences with the MI/FST intervention components and its implementation. Results will continue and expand a novel HVIP aimed at mitigating recurrent firearm injuries in New Orleans—particularly in largely black communities—and inform future studies on the root issues underlying firearm violence recurrence nationwide. This research is significant because it will expand our understanding of the efficacy of community-based HVIPs in New Orleans that decrease the risk of recurrent violent injury in a growing and underappreciated, high-risk population that has already been hospitalized with a firearm injury. This proposal addresses the RFA’s first primary objective by testing the effectiveness of an innovative approach with the potential for immediate and near immediate benefits to reduce community violence and racial/ethnic inequities in risk for community violence.

NCIPC - National Center for Injury Prevention and Control

PROJECT SUMMARY/ABSTRACT This proposal for the K01 Mentored Research Scientist Career Development Award is intended to support my long-term goal of becoming a trailblazing independent investigator dedicated to transforming outcomes and dismantling inequities in youth violence. To reach this goal, I seek to gain the pivotal knowledge and skills to design and rigorously evaluate community-based interventions to reduce youth violence. Firearm injury is the leading cause of death for children and adolescents in the United States, with the burden of these injuries disproportionately born by disadvantaged communities. In this proposal, I seek to address the research priority of youth violence, and specifically firearm injuries, using complex systems science and human-centered design approaches. My central hypothesis is that these tools will allow us to design feasible, acceptable, and effective interventions to reduce youth gun violence. I will pursue the proposed research and career development goals with the following aims: Aim 1. Identify areas of greatest impact for reducing youth firearm violence in Cincinnati using system dynamics modeling. I will use system dynamics modeling and our existing co-produced qualitative map to identify areas within our complex dynamic system where interventions may have the greatest impact on reducing rates of youth firearm violence. I hypothesize that we will identify 1-2 areas ripe for intervention. Aim 2. Co-design an intervention to reduce youth firearm violence in one neighborhood in Cincinnati. I will utilize human-centered design strategies to develop at least one intervention expected to reduce youth violence. I hypothesize that an inclusive community-centered, multidisciplinary team can design a feasible, acceptable, effective intervention targeting upstream structural determinants of youth violence. My training goals for this proposed award are to gain experience in (1) complex systems science methods, (2) human-centered design, and (3) community-engaged participatory research. I seek to position my research and skills at the intersection of these three methodologic approaches. I will use findings and skills gained from this K01 proposal to develop a competitive R21, and subsequently R01, proposal on testing and implementation of the designed intervention. I will complete this proposed work as an Assistant Professor of Surgery and Attending Pediatric Surgeon at Cincinnati Children’s Hospital Medical Center, with significant and enthusiastic support from my divisional and departmental leadership, as well as my proposal mentors.

NCIPC - National Center for Injury Prevention and Control

ABSTRACT Community gun violence (assault or homicide) is the leading cause of firearm injury and death in urban youth in the United States, yet upstream primary prevention efforts are lacking.1-3 Risk factors for community gun violence include aggression and violent conflict resolution, gun carrying, and living in socially and economically disadvantaged neighborhoods with high prevalence of violence.27-30 Youth are not always equipped to make smart or safe decisions regarding fighting, retaliation, and gun use. Additionally, they are easily influenced by social perceptions regarding gun carrying, especially vulnerable in communities where they could easily be victims of violence.20 Mentorship and conflict resolution skills for high-risk youth provided by school-based or community violence interruption programs are effective at reducing community gun violence; however, these services are limited resource-intensive.9-11,36,37 We propose development of a video-based program (“Rise Up Against Gun Violence”) that is informed by youth ambassadors with lived experience and leverages the expertise of violence interrupters to influence adolescents to avoid risky behaviors that lead to community gun violence. The video topics and messaging will be developed by the youth ambassadors and a multidisciplinary team of content experts, and refined through community feedback. The series will focus on risk-reduction topics such as non-violent conflict resolution, avoiding retaliation, and posting safely on social media, and will deliver hard facts about the dangers of firearm injuries and other salient topics that youth identify. Our study design includes youth ambassadors and violence interrupters from two cities with high levels of community gun violence (Houston and Memphis) to work with experts to develop a series of videos. The video program intervention will be tested with youth cohorts (community testers) in diverse settings in high-risk communities in both cities, and a mixed-methods approach will assess attitude change about the consequences of gun carrying and use (primary outcome), behavior change in gun carrying and fighting, increased awareness regarding risks of gun use, and establishment of adult support (secondary outcomes). Our proposal is a novel and innovative, multi-faceted approach, a “plug- and-play” program that could be disseminated to diverse community youth programs to utilize as part of their programming to tackle primary prevention of the leading public health problem for American youth.

NCIPC - National Center for Injury Prevention and Control

Project Abstract The intersection of the overdose and housing crises has prompted unprecedented mortality among our nation’s most vulnerable residents – people who experience homelessness (PEH). Multilevel barriers to care often obstruct this population’s access to medications for opioid use disorder (MOUD) -- a secondary overdose prevention strategy that halves the risk of overdose and improves other health outcomes. To eliminate the barriers associated with traveling to healthcare facilities for MOUD appointments and prescription refills, Public Health – Seattle and King County (PHSKC) will pilot a new MOUD service delivery model. Starting in 2025, buprenorphine prescriptions ordered during street medicine or telemedicine encounters at participating encampments, shelters and permanent supportive housing (PSH) sites will be filled at the Downtown Public Health Pharmacy and transported by a nurse-led care team, who will disburse short-acting sublingual and administer long-acting injectable buprenorphine directly to patients in the field. This study will employ a Type 2 Implementation-Effectiveness Hybrid design to evaluate this pilot program. Using quasi-experimental methods, we will evaluate the effect of community-delivered buprenorphine on (i) the risk of overdose in a propensity score matched patient cohort and (ii) occurrence of overdose at PSH sites, assessed via interrupted time series. Guided by the RE-AIM Implementation Science Framework, we will measure patient-level and systems-level implementation outcomes. This rigorous evaluation will generate real-world evidence for a (i) community-based MOUD delivery model and (ii) long-acting injectable buprenorphine. Findings from this evaluation will inform how these innovations can be adapted and brought to scale both locally and in other jurisdictions that grapple with the syndemic overdose and housing crises.

NCIPC - National Center for Injury Prevention and Control

Wisconsin Opioid Prevention and Treatment Research Network (WI OPTRN) Abstract The opioid overdose crisis remains a major public health emergency, causing over 81,000 deaths in 2023. Emergency departments (EDs) are key settings for intervention, as they frequently treat individuals with opioid overdoses or those at high risk for overdose. Despite this, evidence-based practices such as ED buprenorphine initiation and linkage to ongoing care remain underutilized, representing a significant gap in the continuum of care for individuals with opioid use disorder (OUD). A multidisciplinary team, including addiction specialists, emergency medicine physicians, peer support specialists, human factors engineers, data scientists, and implementation scientists, seeks to address this gap by improving buprenorphine adoption in EDs. The team will use advanced data-driven methods embedded in the electronic health record (EHR), combined with peer-supported care continuity. Surveys of ED clinicians at two University of Wisconsin EDs revealed that clinicians reported that clinical decision support would be a key facilitator for initiating buprenorphine. In response, a clinical pathway for buprenorphine initiation was implemented in 2023, but a follow-up evaluation showed that only 23% patients whose ED visit had a diagnosis of opioid use disorder or opioid overdose received buprenorphine, indicating missed opportunities. To address this, the team proposes an approach integrating artificial intelligence (AI), EHR-embedded clinical decision support (CDS), and peer navigation to improve buprenorphine initiation and linkage to care. The team brings expertise in addiction medicine, implementation science, human-centered design, and clinical informatics, along with input from a Community Advisory Board (CAB) of people with lived experience. The project has three aims. Aim 1 will validate the Opioid AI Screener, a tool previously validated in inpatient settings, to identify patients at high-risk for OUD in the ED with greater than 85% sensitivity and specificity (years 1-4). Aim 2 will involve co-designing and implementing an EHR-embedded CDS to increase buprenorphine initiation in the ED. This system will prompt clinicians when high-risk patients are identified, and offer step-by-step guidance for buprenorphine initiation, management, and automated referral to an outpatient substance use disorder clinic (Years 1-4). Aim 3 will focus on strengthening linkage to community-based OUD care through peer support specialist (PSS) navigation. PSS will conduct outreach, help patients find follow-up care, and address barriers to treatment engagement (Years 1-4). The overarching goal of this project is to create an implementation guide to support wider adoption of buprenorphine initiation in EDs, improving patient outcomes and contributing to broader overdose prevention efforts.

NCIPC - National Center for Injury Prevention and Control

Robust, evidence-based treatments for Opioid use disorder (OUD) exist but substantial gaps remain in utilization and access, especially among marginalized populations. Emergency Departments (EDs), as a locus for 24/7 treatment access is an evidence- based strategy for initiation of buprenorphine with variable adoption. This study aims to evaluate pragmatic strategies to enhance the ED initiation of buprenorphine for OUD, leveraging locally adapted protocols across two health systems, Penn and Jefferson. These strategies include enhanced patient identification through triage screening, clinician supported buprenorphine initiation, specially trained peer navigation and low barrier follow up options via Penn's CareConnect virtual telehealth and Jefferson's Bridge Program. An additional innovation is to assess patient choice in medication strategies by also offering methadone initiation with next day follow up at Opioid Treatment Program (OTP) partners. Through collaboration with stakeholders, including those with OUD lived experience, we will develop a comprehensive toolkit to increase MOUD initiation in EDs, addressing barriers such as lack of clinician experience and follow-up options. We will assess prescribing rates, patient and provider engagement, and MOUD treatment within 30 days of ED discharge. Sustainability will be evaluated by measuring ongoing costs of the programs. Based on our prior experiences leading interventions to enhance MOUD prescribing at our own institutions and across other research networks, we propose organizing a learning and research collaborative as part of the coordinating center role of the Opioid Prevention, Treatment and Research Network (OPTRN) that can be a forum for sharing and vetting strategies to enhance rates of buprenorphine and methadone initiation. The learning collaborative will leverage the experience of collaborating sites within the network that demonstrate higher rates of buprenorphine initiation as well as visiting “content experts” who can contribute to focused webinars to address implementation and uptake challenges and to support the sites in evaluating outcomes across the network. We will also develop a network website as a communication and sharing platform to enhance shared knowledge and approaches especially important in a community of emergency clinicians with highly variable clinical schedules. Our findings will inform the development of scalable, sustainable interventions to reduce overdose-related mortality.

NCIPC - National Center for Injury Prevention and Control

PROJECT SUMMARY Falls are a major cause of injury and disability for older adults. In assisted living communities, 50% of residents fall each year and 25% will have a fall that requires transfer to the hospital. Falls are a common reason for residents to transfer from assisted living to nursing homes. Approximately 30% of falls can be avoided with proper screening and intervention. STEADI is an evidence-based falls prevention program developed by the CDC and tested in several community-based setting. STEADI involves universal fall screening, followed by personalized assessments and tailored interventions. Common, potentially modifiable causes of falls evaluated in STEADI include medication interactions or side effects, environmental hazards (e.g., floor rugs, thresholds), untreated visual impairment, low vitamin D, ill-fitting footwear, or low blood pressure. The goal of this research is to adapt STEADI to the assisted living setting. First, we will conduct structured observations of current processes for fall risk evaluation and interview staff about how best to adapt STEADI to the assisted living environment. Next, we will draft a modified version of STEADI, with technical expert and assisted living corporation input. Finally, we will test the new assisted living (AL)-STEADI in seven communities. New and existing residents will be randomly assigned to AL-STEADI (intervention) or a usual fall prevention control. We will evaluate the effect of the intervention on the number of falls per 12 months. Planned and unplanned adaptations to the AL-STEADI protocol will be systematically. The outcome of this work will be AL-STEADI, an Implementation Plan, Toolkit, and training materials adapted to the needs of the ALC environment, with preliminary evidence for its effectiveness. In addition to traditional dissemination routes, we will publish an implementation guide for ALCs, which highlights the technical support needs which would make AL-STEADI more scalable and help adhere to state-specific ALC regulations.

NCIPC - National Center for Injury Prevention and Control

1 Problem sexual behaviors (PSB) by adolescents account for a significant proportion (50-70%) of harmful 2 sexual behavior experienced by children, as reported in national surveys. Many—perhaps most—sexual harm 3 incidents committed by teenagers can be characterized as "crimes of opportunity" or "crimes of ignorance." 4 Teens are at risk of engaging in PSB due to a lack of knowledge and clear guidance regarding appropriate and 5 inappropriate sexual behaviors, consent, and the developmental differences between teens and younger 6 children. School-based preventive interventions have been developed to address PSB; however, most, if not 7 all, of these interventions have been designed for and evaluated with general samples of adolescents, their 8 families, and educators. The proposed research aims to address the gap that exists for teens with intellectual 9 and/or developmental disabilities (IDD), as well as their families and educators, who have been largely 10 neglected in PSB prevention efforts. This gap represents a missed opportunity to prevent children from being 11 victimized by PSB and to interrupt a destructive cycle for teens at risk of engaging in PSB. The overarching 12 goals of the proposed study are to establish the acceptability, feasibility, and safety of a PSB prevention 13 curriculum and related study procedures for teens with IDD and to evaluate its efficacy in a waitlist randomized 14 controlled trial. Our team developed the Responsible Behavior with Youth and Children (RBYC) intervention as 15 a school-based program to prevent the onset of PSB among neurotypical teens. In collaboration with IDD 16 experts, we adapted RBYC for use with teens with mild to moderate IDD ages 14 to 19. Following principles of 17 community-based participatory research, we partnered with teens with IDD, their parents, and educators to 18 adapt the content and develop educational videos. RBYC-IDD is an 8-session curriculum designed to promote 19 safe and appropriate interactions between teens and younger children and peers, both in person and online. 20 Specifically, we aim to: (1) Ensure acceptability, feasibility, safety, and utility of a classroom-based universal 21 intervention and procedures to assess intervention effects on the prevention of PSB by teens with IDD; (2) to 22 evaluate the immediate effects (pre-post design) and sustained effects (3-month follow-up) of RBYC-IDD on 23 targeted constructs; and (3) to assess the differential impact of RBYC-IDD based on student characteristics 24 including sex, prior history of child maltreatment victimization, and student disability type and severity. To 25 complete study RCT we will recruit 12 special education schools in Maryland. Schools will be randomly 26 assigned to either the intervention group (6 schools) or the control group (6 schools). Participating students 27 (~150), their parents (~150), and teachers (~24) will complete assessment batteries at pre-intervention, post- 28 intervention, and at the three-month follow-up. We aim to establish an initial evidence base for RBYC-IDD. To 29 our knowledge, this will be the first school-based universal program designed to address the onset of PSB 30 among teens with IDD—a largely overlooked gap in PSB prevention.

NCIPC - National Center for Injury Prevention and Control

Project Summary Abstract Child sexual abuse (CSA) and problematic sexual behavior (PSB) among youth are pervasive public health issues with significant physical, emotional, and societal impacts requiring community-level interventions. This evaluation is a field experiment designed to test the effectiveness of Teen Safety Matters (TSM), a school- based prevention program developed and implemented in multicultural school settings to equip both middle school adults and students with the knowledge and skills to identify and prevent CSA and PSB. This researcher-practitioner partnership will be conducted in a community population (New York City Public Schools) that is not only racially and ethnically diverse, but also serves learners who are predominantly economically disadvantaged (four out of five) among other vulnerabilities that confer disproportionate risk of CSA and PSB. The program evaluation has three specific aims: (1) Conduct a randomized controlled trial to assess the effectiveness of the TSM program on middle school students’ CSA and PSB outcomes; (2) Investigate the durability of TSM effects throughout middle school and into the first year of high school; and (3) Assess the differential impact of TSM on student outcomes by demographic subgroups. The study will engage 40 middle schools which will be randomized into one of two experimental conditions—TSM for students and school adults (Condition A), TSM for school adults only (Condition B)—or to the control condition (business as usual) in which school are eligible for delayed rollout. Data will be collected from adults and students at baseline, after one year, after two years, and (for the two older student cohorts) during high school. The primary adult outcomes are their preparation and actions for the prevention of CSA and PSB. The primary student outcomes include program effects on their knowledge, social-emotional competencies, skillsets and safety outcomes relevant to the prevention of PSB. Analyses of the outcomes for participants in Condition B will yield insights about the value of extra training for school adults to shift the middle school environment towards prevention; compared to the Control condition, we will learn if TSM for School Adults is by itself an effective intervention. Similarly, analysis of the outcomes for participants in Condition A will provide information on the efficacy of the combination of TSM for School Adults and classroom instructional time. Finally, because educating youth to prevent PSB will always remain an important learning goal for this age group, direct comparison of Condition A to Condition B will yield information about the relative value of added classroom instructional time compared to TSM for adults only. Key innovations include TSM’s adult-focused training component, a rules-based approach, a flexible delivery model requiring less instructional time, and a dual focus on preventing negative outcomes while promoting positive developmental competencies. Methodological innovations include examining cumulative and cross-sectional effects across three student cohorts and evaluating practices for Safe Adult and Safe Peer-to-Peer Communications to prevent CSA and PSB.

NCIPC - National Center for Injury Prevention and Control

Abstract: The US opioid epidemic has significantly impacted public health, with high levels of opiate dependence and a surge in overdoses. The increasing prevalence of fentanyl and xylazine in the drug supply underscores the importance of novel approaches. Additionally, times of withdrawal have been found to increase overdose risk behaviors, highlighting a need to target this period. Particularly in the context of xylazine, as naloxone does not reverse the effect of xylazine-induced respiratory depression, enrollment and retention in medications for opioid use disorder (MOUD) is vital to reduce drug overdoses. In our prior work, we have shown that PWUO can be trained as peer educators (PEs) for overdose prevention, but we have not integrated withdrawal management or a social network approach to MOUD engagement. This five year proposal seeks to develop, implement, and rigorously evaluate a novel PE intervention designed to prevent overdoses and promote MOUD and drug use cessation among a population of PWUO disproportionally impacted by overdose (Funding Option B). The intervention has three novel components: (a) social network diffusion of overdose prevention and MOUD promotion, (b) strategies to address high-risk withdrawal periods, and (c) Certified Peer Recovery Specialist (CPRS)/ Contingency Management (CM) for MOUD engagement. Using an RCT study design, 300 index PWUO will be recruited along with 300 of their network members who use opioids. The indexes will be randomly assigned to the (1) standard of care (SOC) or (2) an experimental peer education condition (PEC). The proposed design allows for the examination of the effectiveness of the intervention on indexes and diffusion of behavior change to network members. The RE-AIM framework will guide the collection of qualitative interview data to identify barriers and facilitators to intervention implementation. Assessments will occur every 3 months for one year. 1. Development and Pilot Testing: Design and pilot test intervention components that diffuse overdose prevention behaviors and MOUD within social networks, promote overdose prevention during withdrawal, and enhance MOUD engagement through CPRS/CM. 2. Implementation of RCT: Evaluate the intervention in a 1:1 RCT, testing an intervention that includes (a) social network diffusion of overdose prevention and MOUD promotion, (b) strategies to address high-risk withdrawal periods, and (c) CPRS/CM for MOUD engagement (N=600; 300 index participants, 300 network members). 3. Evaluation of Outcomes: Assess changes in nonfatal overdose, drug use cessation, MOUD engagement, and overdose prevention behaviors among index participants, as well as the diffusion of these behaviors to their social network members.

NCIPC - National Center for Injury Prevention and Control

PUBLIC ABSTRACT Pregnant persons shoulder disproportionate burdens related to the US overdose epidemic. This burden is demonstrated by a quadrupling of births complicated by opioid use disorder (OUD) in the past two decades. This burden is also evident in that pregnant persons with OUD have elevated rates of HIV/HCV, psychiatric conditions, health-related social needs, and neonatal health challenges. Non-opioid substance use disorder, particularly stimulant use and disorder (StUD), is highly common and markedly increasing among pregnant per- sons with OUD. While recommended care for pregnant persons with OUD includes medication for opioid use disorder (MOUD) combined with behavioral health services—current research is unclear regarding which be- havioral health model(s) are optimal for addressing OUD with or without StUD (OUD±StUD), promoting treatment linkage/retention, and preventing overdose—while also addressing co-occurring psychosocial problems. One promising approach is patient navigation (PN), an evidence-based practice for a variety of medical and psycho- social conditions. Our preliminary studies have demonstrated that compared to Usual Care (UC), PN can pro- duce superior outcomes for MOUD adherence, drug treatment attendance, illicit opioid use, and overdose. Also, nearly all participants in our preliminary studies have been Medicaid beneficiaries, suggesting Medicaid pro- grams may be optimal partners to scale and sustain PN. Yet, while our PN model has robust preliminary evi- dence—it lacks tools to maximize benefit for co-occurring StUD. To enhance our PN model’s ability to address StUD for patients with OUD within Medicaid programs, we propose this mixed methods, type-2 hybrid implemen- tation study. First, we will further develop PN to target StUD in addition to OUD among pregnant persons. To do so, we will expand our PN model to include contingency management, a highly effective evidence-based inter- vention for addressing StUD. Completing this step positions our PN model for implementation planning and testing. Second, we will collaborate with Medicaid leaders, health care professionals/staff, and Medicaid benefi- ciaries to co-develop a PN implementation strategy for Medicaid. We will perform a contextual inquiry using qualitative interviews with Medicaid leaders (N=20) and four focus groups, two with obstetric/pediatric health professionals/clinic staff and two with persons with lived experience (6-8 participants per group). Results will be used to develop a Medicaid implementation guide for the current study and future real-world PN implementation in Utah Medicaid and other states. Last, we will implement and test PN vs. UC for opioid ± stimulant use reduc- tions/outcomes among pregnant persons. Partnering with Utah Medicaid, the University of Utah Health Plans, and Health Choice Utah Medicaid programs, we will conduct a powered randomized trial. Participants (N=429) will be assigned 1-1 to PN or UC. We hypothesize PN participants will have more opioid ± stimulant free days vs. UC. This study establishes needed evidence to aid pregnant persons to reduce illicit use, prevent overdose, and improve health outcomes.

NCIPC - National Center for Injury Prevention and Control

ABSTRACT Millions of Americans engage in substance use (SU), which poses myriad adverse health effects including risk for overdose. Consistent with RFA-CE-25-149, there is a critical need to develop, implement, rigorously evaluate, and scale feasible and efficacious approaches to Screening, Brief Intervention, and Referral for Prevention for individuals engaging in at-risk SU (SBIRP). Emergency departments (EDs) provide a unique opportunity to access the general population including young, diverse, and disadvantaged individuals to provide SU SBIRP who otherwise cannot or do not access other care and services. This proposal seeks to leverage the ED setting for an SBIRP approach paired with a subsequent telehealth-delivered motivational interviewing (MI) prevention program to avert the development of substance use disorders (SUD) in populations engaged in at-risk SU. We aim to: 1) Evaluate the efficacy of Emergency Department- Substance use screening, Motivational interviewing and Active Referral Targeting substance use disorder and overdose prevention (ED-SMART) for patients with at-risk SU. Using an established, ED-based at-risk SU screening approach, we will enroll a sample of consenting participants with at-risk SU use via recommended measures (N=650) in a two-arm RCT comparing (i) a brief, single session, ED-delivered MI intervention plus referral for 5, monthly, brief telehealth MI sessions to (ii) an SU informational control condition. Assessments will occur at baseline (prior to randomization) and at 1- and 6-months post- baseline. We hypothesize that ED-SMART will have greater reductions in SU (primary outcome) relative to control at 6 months. We will secondarily evaluate: (i) incidence of positive screen for SUD, (ii) changes from baseline in proportion with positive biological toxicology assays for SU, (iii) self-reported healthcare utilization, and (iv) frequency of fatal and non-fatal overdose. 2) Characterize ED-SMART feasibility, acceptability, and processes in preparation for future clinical implementation. We will (i) measure intervention dose, (ii) conduct time and motion observations of resource requirements for intervention delivery (ED and telehealth), and (iii) engage (n=30) patients (both completing ED-SMART and declining AIM 1 study), and (n=50) ED nurses, physicians, and administrators in planning for a future effectiveness- implementation hybrid trial. Using mixed-methods guided by Consolidated Framework for Implementation Research constructs, we will evaluate perceived feasibility, acceptability, and organizational readiness after sharing AIM 1 efficacy results and develop an operational plan for clinical ED-SMART implementation. Should ED-SMART not demonstrate efficacy, participants will also engage in a rigorous assessment of possible alternative intervention targets. This high impact research promises to launch a new paradigm in emergency care and overdose and SUD prevention. At scale, innovations to optimize and implement ED- SMART in the ED could provide meaningful reductions in the prevalence of SUD and overdoses.