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Supporting Treatment Access and Recovery through Linkage Support (STAR-LS)

HSS Investigator: David Smelson
Funding Agency: CDC
Status: Ongoing

Project Overview: Addiction is a growing public health problem in the United States (U.S.), with nearly 21 million Americans meeting criteria for substance use disorder (SUD) in 2019, and 1.6 million having an opioid use disorder (OUD). Despite OUD being declared a public health epidemic in 2017, opioid-related overdoses have increased by about 50% over the past 5 years. Comorbid mental illness among individuals with SUD (COD) is also high, with 49% having any mental health disorder, and 19% having a severe mental health disorder. Individuals with COD are vulnerable to substance use relapses, mental illness exacerbations, overdoses, homelessness, and criminal involvement. However, despite high rates of morbidity, mortality, polysubstance use, and broad social determinant of health needs, only 8% of individuals with a COD in the U.S. received treatment for both mental illness and SUD. Both linkage and multicomponent wraparound models have gained popularity for increasing treatment access and engagement. Maintaining Independence and Sobriety through Systems Integration Outreach and Networking (MISSION) is a hybrid, multicomponent linkage and treatment approach, in which a Case Manager and Peer Specialist team provides 6 months of linkage support and psychosocial treatment as a bridge to help patients access and engage in needed community services following an acute episode. MISSION is aligned with the Social - Ecological Model (SEM) to address multilevel patient needs via 3 evidence-based practices. They are: 1) Critical Time Intervention (CTI), a time-limited form of assertive outreach, in which Case Managers and Peer Specialists link patients to behavioral health and recovery resources; 2) Dual Recovery Therapy (DRT) 13 mental health and substance use group sessions delivered by a Case Manager to teach initial COD skills; and 3) Peer Support (PS), 11 peer group sessions to support early recovery. This project tests MISSION via a 3-year, Hybrid Type 1 Randomized Controlled Trial in the Hub, a program in city hall, run by the Worcester’s Health and Human Services in MA. The Hub collaborates with over 30 agencies and receives referrals from one of the busiest Emergency Medical Service Lines (i.e., 911) in the state. This study will randomize 208 people with COD to 6 months of 1) MISSION, a multicomponent treatment and linkage model, or 2) Peer Support, offering linkage only. Participants will receive baseline, 3-, 6- and 9-month assessments as part of a process and outcome evaluation. Study aims include: Aim 1: To evaluate the effectiveness of MISSION compared to Peer Support; Aim 2: Examine mechanisms impacting Aim 1 outcomes; and Aim 3: Conduct a sequential mixed methods process evaluation to inform sustainability and future implementation of MISSION.

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