The purpose of this study is to develop and then test an enhanced version of the parent study's collaborative care intervention for co-occurring disorders (CC-COD) to reduce the risk of suicide and overdose among individuals with opioid use disorder (OUD) in combination with PTSD/depression. The parent study is CLARO, Collaboration Leading to Addiction Treatment and Recovery from Other Stresses (NCT04559893).
People with OUD co-occurring with depression or PTSD (COD) may not seek out treatment for their substance use or mental health issues, but they do visit their primary care provider. However, because providers generally lack specialized training in substance use and mental illness and are focused on the immediate reason for the visit, patients' substance use and mental disorders often go unrecognized and untreated. This missed opportunity can have lethal consequences. Individuals with COD are at higher risk of dying from suicide or overdose than individuals with mental illness or OUD alone. The parent study (NCT04559893) will provide a definitive answer as to whether collaborative care (CC) improves access, quality, and outcomes of care for individuals with COD. While a primary goal is to improve access to and retention in medication treatment for OUD (MOUD) (which is linked to decreased mortality and overdose risk), the interventions CC-COD supports do not proactively address suicide or overdose risk, an important limitation. In addition, CC-COD does not include families in the patient's care. The investigators address these limitations and tackle the public health crisis of increasing deaths from suicide and overdose with this study. Because family members can play an important role in a patient's decision to engage with treatment and in overdose and suicide prevention, the study team investigates family members' views and use this information to strengthen CC-COD. This revision will develop and then test the incremental effectiveness of three additional CC-COD components. Care coordinators will (1) educate family members about MOUD with the goal of increasing patient retention in treatment; (2) train family members and the patient to administer naloxone and on how to reduce overdose risk behaviors; and (3) implement Caring Contacts, a suicide prevention intervention that sends compassionate mailed or text messages to individuals to decrease social isolation and reduce suicide risk.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
68
Collaborative care consists of a team of providers that includes a care coordinator, a primary care provider (PCP) and a behavioral health consultant (BHC), who provide evidence- and measurement-based care to a panel of patients using a clinical registry. In this model, the CC team also includes a behavioral health psychotherapist (BHP) who consults on a regular basis but does not deliver direct care. In the Collaborative Care Plus condition, the care coordinator involves family in care, teaches family about naloxone use, and provides Caring Contacts, a suicide prevention method, to patients.
Hubert Humphrey Comprehensive Health Center
Los Angeles, California, United States
Providence Saint John's Health Center
Santa Monica, California, United States
First Choice Community Healthcare - South Broadway Medical Center
Albuquerque, New Mexico, United States
First Choice Community Healthcare - South Valley Medical/Dental Center
Albuquerque, New Mexico, United States
First Choice - Alameda Medical Center
Albuquerque, New Mexico, United States
First Choice Community Healthcare - North Valley Medical Center
Albuquerque, New Mexico, United States
University of New Mexico Family Health Clinic, North Valley
Albuquerque, New Mexico, United States
University of New Mexico Family Health Clinic, Southeast Heights
Albuquerque, New Mexico, United States
First Choice Community Healthcare - Alamosa Medical Center
Albuquerque, New Mexico, United States
First Choice Community Healthcare - Belen Medical Center
Belen, New Mexico, United States
...and 2 more locations
MOUD continuity of care
Max number of continuous (i.e., no breaks of more than 7 days) days the patient receives MOUD in the 180 days after study enrollment; obtained from electronic health record (EHR) or from the Prescription Drug Monitoring Program for the State of New Mexico
Time frame: Assessed over the first 180 days after study entry
Opioid overdose risk behaviors
Measured as a sum of ratings on 9 risk behaviors from Opioid Overdose Risk Assessment (score 0-36). A high score indicates high risk.
Time frame: Assessed over the previous 30 days at study entry and at 3 and 6 months after study entry
Suicide risk
Measured using Columbia Suicide Severity Rating Scales, classified into 6 levels (from no risk to suicide attempt)
Time frame: Assessed over the previous 30 days at study entry and at 3 and 6 months after study entry
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