Improving Jail Response to the Overdose Crisis: A Hybrid Trial of Jail ECHO to Improve MOUD Implementation and Public Health Outcomes

About This Grant

The overdose crisis continues to devastate communities across the United States, with justice-involved individuals at particularly high risk of adverse outcomes. Despite a constitutional obligation to provide medical care, only 20% of jails offer medication for opioid use disorder (MOUD) to those eligible, often with limited access. Rural jails, which comprise 66% of all jails, face significant operational and logistical challenges to implementing MOUD programs, creating variability in access to evidence-based care. This study aims to test the effectiveness of Jail ECHO Operations, Planning, and Strategy (J-ECHO OPS), an innovative implementation strategy designed to increase access to MOUD in rural jails. Using a Type 2 hybrid trial stepped wedge design, we will recruit 40 rural jails nationally. J-ECHO OPS, based on the Project Extension for Community Healthcare Outcomes (ECHO) model, will provide semi-monthly virtual learning sessions, case-based discussions, and peer-to-peer learning to jail leadership, jail staff, and community MOUD professionals. The Exploration, Preparation, Implementation, Sustainability (EPIS) framework will guide system change, while the opioid cascade of care will inform best practices. Aims: (1) Test J-ECHO OPS effectiveness on implementation outcomes: MOUD reach, penetration, adoption, sustainability, and cost. (2) Evaluate J-ECHO OPS impact on workforce-level outcomes: MOUD knowledge, attitudes, commitment, efficacy, readiness for change, negative attitudes, and unfair treatment. (3) Assess J-ECHO OPS effects on organizational climate outcomes (diversion, disciplinary infractions, violence involving staff and residents, and conveyance of drug contraband). The team represents a strategic partnership among UMass Chan Medical School, Project ECHO® Institute at the University of New Mexico, the American Correctional Association (ACA), and the American Association for the Treatment of Opioid Dependence. This multidisciplinary team is well-positioned to test overdose prevention strategies in criminal legal settings, with expertise in implementation science, systems change, and leverages ACA’s unparalleled authority as the primary standard-setting and accrediting body for U.S. correctional facilities, ensuring that our MOUD implementation strategies align with industry best practices and have the potential for widespread adoption across the nation's jails. By fostering intercommunication, professional development, and capacity building among correctional and public health stakeholders, this project aims to improve MOUD implementation in rural jails, potentially preventing thousands of overdoses annually and mitigating measurable variability in health outcomes in this high-risk population