This study explores efforts to elevate youth and family voice within Children’s Systems of Care (SOC)-based Interagency Coordinating Councils (ICCs). Children’s SOC principles emphasize youth- and family-driven service provision and require close collaboration between community-based providers to ensure services are responsive to family need. ICCs work to coordinate the efforts of SOC providers and represent a key avenue for incorporating lived experience into community planning efforts.Using a mixed-methods design, archival records from 377 ICC meetings and 18 in-depth interviews with ICC members were used to explore youth and family engagement by ICCs. Analysis of archival documents revealed significant increases over time in agenda items and meeting discussion focused on engaging youth and families as well as increased attendance by youth and family members. Three core themes were identified in interviews with ICC members: (1) the centrality of youth and family voice in improving SOC quality; (2) structural, cultural, and individual challenges to youth and family integration on ICCs; and (3) the use of culturally responsive recruitment, orientation, and advocacy training as strategies to increase youth and family participation. ICCs with prior commitment to inclusion reported stronger integration of youth and family perspectives. Findings suggest meaningful inclusion of youth and family voice requires clearly defined roles, participant training, and accountability structures to ensure youth and family voice drives system improvements. Findings from this study highlight ICCs as promising spaces for engaging youth and family perspectives and underscore the utility of youth and family voice in community planning and system-level reform.

Resource parents provide crucial services in systems of child welfare and must be prepared to manage a range of behaviors. The Nurtured Heart Approach (R) (NHA (R)) is a promising method to build positive parenting skills, but its effectiveness among resource parents remains unexplored. This mixed methods exploratory study evaluated NHA (R) training among resource parents in a system of child welfare services. Quantitative analyses revealed significant improvements in alignment with NHA (R) principles. Qualitative findings indicated an overall positive reception to NHA (R) and the desire for additional support addressing higher levels of need for some children in out-of-home care.

Background: Peer recovery programs increase recovery support and treatment engagement among individuals with opioid use disorder. Peer recovery specialists (PRS) are critical in the cascade of care of treating addiction and related conditions. Work remains to help identify the benefits of PRS, particularly time spent with a PRS as a clinical indicator associated with referral to substance use treatment services. Gaps in the literature do not consider the nested hierarchical intercorrelations of opioid recovery data within multiple emergency departments. Purpose: The current study examined demographic and clinical correlates with referral to substance use treatment services including prior engagement within an opioid overdose recovery program, mental health diagnosis, the number of naloxone administrations, prior overdoses, and hospital-level variability of PRS time associated with treatment referrals. Method: This study used data collected by providers among patients who engaged in an opioid overdose recovery program. Data were collected between January 2016 and September 2020. Generalized linear mixed effect multilevel regression analyses tested the associations on clinical referral to substance use services. Results: A total of 5655 patients participated in the study (male: 68.91%; age: mean = 37.75 ± 12.43; White non-Hispanic: 62.48%). Significant individual-level associations were identified between demographic and clinical variables and referral to substance use treatment services. At the hospital level, recovery specialist time spent with the patient also showed a positive and significant association with referral to substance use treatment services. Conclusion: The cross-level interaction effect displayed that any period of time spent with PRS played an important role for those patients with a greater number of prior overdoses on referral to treatment. Results provide important information on the role of PRS in the cascade of care, as well as the time spent with those in this role for both individuals with varying number of prior overdoses.

ImportancePatients treated in emergency departments (EDs) for opioid overdose often need drug treatment yet are rarely linked to services after discharge. Emergency department–based peer support is a promising approach for promoting treatment linkage, but evidence of its effectiveness is lacking.ObjectiveTo examine the association of the Opioid Overdose Recovery Program (OORP), an ED peer recovery support service, with postdischarge addiction treatment initiation, repeat overdose, and acute care utilization.Design, Setting, and ParticipantsThis intention-to-treat retrospective cohort study used 2014 to 2020 New Jersey Medicaid data for Medicaid enrollees aged 18 to 64 years who were treated for nonfatal opioid overdose from January 2015 to June 2020 at 70 New Jersey acute care hospitals. Data were analyzed from August 2022 to November 2023.ExposureHospital OORP implementation.Main Outcomes and MeasuresThe primary outcome was medication for opioid use disorder (MOUD) initiation within 60 days of discharge. Secondary outcomes included psychosocial treatment initiation, medically treated drug overdoses, and all-cause acute care visits after discharge. An event study design was used to compare 180-day outcomes between patients treated in OORP hospitals and those treated in non-OORP hospitals. Analyses adjusted for patient demographics, comorbidities, and prior service use and for community-level sociodemographics and drug treatment access.ResultsA total of 12 046 individuals were included in the study (62.0% male). Preimplementation outcome trends were similar for patients treated in OORP and non-OORP hospitals. Implementation of the OORP was associated with an increase of 0.034 (95% CI, 0.004-0.064) in the probability of 60-day MOUD initiation in the half-year after implementation, representing a 45% increase above the preimplementation mean probability of 0.075 (95% CI, 0.066-0.084). Program implementation was associated with fewer repeat medically treated overdoses 4 half-years (−0.086; 95% CI, −0.154 to −0.018) and 5 half-years (−0.106; 95% CI, −0.184 to −0.028) after implementation. Results differed slightly depending on the reference period used, and hospital-specific models showed substantial heterogeneity in program outcomes across facilities.Conclusions and RelevanceIn this cohort study of patients treated for opioid overdose, OORP implementation was associated with an increase in MOUD initiation and a decrease in repeat medically treated overdoses. The large variation in outcomes across hospitals suggests that treatment effects were heterogeneous and may depend on factors such as implementation success, program embeddedness, and availability of other hospital- and community-based OUD services.

The concurrent use of opioids and alcohol is particularly dangerous for individuals. Alcohol is commonly seen in opioid overdose death toxicology reports and, concurrent use of alcohol and opioids is often reported by individuals across a diverse range of opioid use profiles. This study investigates whether there is a community-level relationship between alcohol sales and opioid-related overdose deaths to inform the situating of harm reduction efforts in spaces most likely to reduce substance-related harms. Using an ecological design, zip code-level data for New Hampshire were combined from the US Census Bureau’s American Community Survey (sociodemographics), the National Alcohol Beverage Control Association (alcohol retail sales), and the NH Office of the Chief Medical Examiner (zip code level opioid poisoning deaths) to investigate the relationship between alcohol sales and opioid-related poisoning deaths at a community level in a state with the third highest rate of opioid poisoning deaths for the year the current study represents. Using a spatial error regression model approach, opioid-related poisoning deaths were higher in zip codes with greater population density and on-premise alcohol sales and were lower in zip codes with greater off-premise alcohol sales and area disadvantage. The findings here co-locate higher levels of on-premise alcohol sales and opioid-related poisoning deaths at a community-level, mirroring individual-level findings on the danger of mixing these two substances. Results inform harm reduction approaches by identifying substance use spaces where overdose prevention messaging or policy change may be most effective.

The opioid crisis has resulted in unprecedented rates of overdose, yet much remains unknown about the locational and contextual attributes of overdose events. This study aimed to identify settings of nonfatal opioid overdose and their individual and community level predictors. Data from 3,326 overdose events show that residences are the most common overdose setting. Compared to overdoses occurring in residences, outdoor overdoses were more likely in communities with higher area deprivation index and population density, and overdoses in nonresidential settings were more likely among unhoused individuals. Findings demonstrate the need for comprehensive, yet tailored and localized approaches to overdose prevention.

Background To respond to the COVID-19 pandemic, the Substance Abuse and Mental Health Services Administration-funded Technology Transfer Centers had to rapidly adapt to ensure that the behavioral health workforce had continuous access to remote training and technical assistance (TTA). Although the Technology Transfer Centers have historically relied partially upon virtual methods for delivering TTA, the shift to a strictly virtual approach necessitated by COVID-19 restrictions has raised new questions for how to best proceed with services when social distancing guidelines are relaxed. The objective of this exploratory paper was to compare TTA provision in the six-month period prior to (9/1/19 thru 2/28/20) and during (4/1/20 thru 9/30/20) early COVID-19 restrictions to determine the extent to which the shift to virtual service provision impacted the behavioral health and medical workforce. Specifically, we examined participants’ access to TTA, geographic reach of TTA, and workforce perceptions of satisfaction and utility with TTA provision. Method Participant and event-level data were analyzed to compare the following metrics before and during the COVID pandemic: number of events and attendees; participant demographics; zip codes reached; coverage of rural, suburban, and urban areas; and perceptions of satisfaction with and utility of training. Results Findings showed a 40% increase in the number of events delivered ( p < .001 ) and a 270% increase in the number of attendees (p < .001 ) during the COVID period when TTCs relied exclusively on virtual delivery. Geospatial analyses linking zip codes to a schematic of rural, suburban, and urban classifications throughout the United States revealed significant increases in the number of zip codes reached during the COVID time period. Satisfaction levels were comparable before and during the pandemic. Conclusions Findings show that expanded access to TTA services via virtual formats resulted in reach to more diverse attendees and regions, and did not come at the expense of satisfaction. Results suggest that virtual TTA should continue to be an important component of TTA offerings post-pandemic.

The increasing popularity of electronic nicotine delivery systems (ENDS) and the relationship of adolescent ENDS use to tobacco consumption in adulthood underscore the importance of effective prevention education. Prevention messaging relevant to youth curiosity about ENDS may serve to improve tobacco control strategies. ENDS-related questions were extracted from 10 years of transcripts of the National Institute of Drug Abuse’s Chat Day initiative, where youth engage anonymously with substance use experts. A content analysis of youth questions was completed to identify the concerns of youth and document changing ENDS nomenclature. Analysis revealed 10 topics depicting youth curiosity about ENDS and documented the changing terms youth use to refer to ENDS. These topics inform youth-focused prevention curricula by identifying content areas that resonate with youth concerns.

Background The coronavirus disease-2019 (COVID-19) pandemic has disrupted life around the globe and has the potential to seriously impact alcohol consumption for individuals experiencing social isolation and pandemic-related stress. Evidence from prior epidemics suggests increased alcohol consumption during quarantine and times of high stress are associated with a greater chance of developing an alcohol use disorder (AUD). This study examines alcohol sales data to ascertain how individuals are interacting with alcohol during the pandemic. Materials and method Monthly off premises alcohol sales data for select US alcoholic beverage control states were used to construct monthly sales patterns from 2015 to 2020. An independent samples t-test was used to determine if COVID-19 era alcohol sales were higher than those that occurred from 2015 to 2019. Results Alcohol sales from March to August 2020 were significantly higher than sales from the same span of months from 2015 to 2019 ( t=–2.47, p<.05). The associated monthly percentage increase in sales ranged from 14 to 44% with the overall trend indicating a move toward pre-pandemic sales totals. Conclusions As COVID-19 continues to disrupt typical ways of being across the globe, the implications of increased sales of alcohol should not be overlooked. Taken together, the evidence on increased use during isolation and later AUD diagnosis coupled with the ABC state sales figures here, point to a potential increase in the development of AUD and an increase in alcohol-related harms.

Psychological empowerment (PE) is a multidimensional construct comprised of emotional, cognitive, behavioral, and relational domains. Although context-specific measures of PE exist, no study to date has introduced and tested a measure of the construct that captures all four domains for both women and men in recovery from substance misuse. Furthermore, research has largely neglected the relational dimension, particularly in studies involving people in recovery. In this study, we tested a measure of PE among a diverse sample (n = 200) of people in recovery who participated in a program designed to expand access to medications for opioid use disorder in the northeastern United States. Factor analysis results supported the hypothesized four-factor structure of the scale, and dimensions of PE were found to be associated in expected ways with measures of quality of life, self-reported health, and depression. Implications of the study are described and directions for future research discussed.

Primary prevention initiatives specifically designed for youth are an important strategy to combat the opioid crisis in the United States. The developmental period of adolescence is critical for impacting lifetime patterns of opioid misuse. Providing youth with relevant information to guide decisions around initiation of drug use may reduce the most serious opioid related harms. Prevention interventions have primarily been developed by experts in the field, with little emphasis on addressing the desires of youth. This study is a content analysis of opioid related questions posed by youth to substance use experts during the National Institute on Drug Abuse's Chat Day program. Findings indicate youth could benefit from definitional information about opioids, the relative risk of opioid use, and the development and outcomes of dependence. Implications for addressing youth curiosity about the use of opioids and youth exposure to opioid use and related harms are discussed within conceptual categories for prevention curricula.

BACKGROUND:The spatial distribution of substance use services impacts their use, with greater access to services associated with more positive outcomes. Findings from availability of primary healthcare indicate service shortages exist in areas characterized by social deprivation. This study investigated whether community social deprivation was associated with a lack of availability of substance use treatment or mutual aid recovery support services.METHODS:This is an ecological analysis investigating the availability of substance use services at a community level in the state of New Hampshire. Several public data sources were combined to represent community social deprivation and availability of substance treatment of mutual aid recovery support groups. Principal components analysis and negative binomial regression were used to test the relationship between community structure and the availability of substance use services.RESULTS:Community social deprivation was characterized by high rates of poverty, no access to motor vehicles, renter-occupied housing, less than a high school degree, and nonemployment. Communities high in measures of social deprivation were associated with increased availability of both substance use treatment and recovery support services.CONCLUSIONS:Contrary to findings in access to primary healthcare services, social disadvantage was positively related to availability for both types of substance use services. This relationship may reflect the stigma associated with substance use where services associated with stigmatized conditions locate in areas with the least resistance to their presence or be a function of affordability of space. Future research could investigate the relationship between access to services and individual client outcomes.

This article presents results from an exploratory study conducted as a component of an assessment of the implicit curriculum in one master's-level social work program. Web-based surveys were used to collect data from 80 graduate social work students in online and face-to-face programs. Findings indicate students who perceived social media as more useful reported higher levels of engagement and participation in program governance. The implications for social work education deal with the ability to competently use social media as a tool to increase student engagement. Students will only be exposed to elements of the implicit curriculum if they are active participants in their academic environments.

The United States has seen a crisis in the use and abuse of opioids since 2000 that has had impacts for the health care, criminal justice, and child welfare systems. After more than a decade of declines in out-of-home care placements, the increases in the last half of this decade may be attributed to parental misuse of opioids. While much is known about infants who are born drug exposed and the ramifications for child welfare practice and policy, less is known about children who grow up in homes with parental misuse of opioids. This study is a descriptive literature review that aims to provide child welfare practitioners with information on the behavioral and substance abuse outcomes for older children and youth who live with parents who have an opioid use disorder. Implications of this body of research may aid in developing appropriate assessment and intervention tools for youth who present for services from opioid-involved homes.

ABSTRACT The United States has seen a crisis in the use and abuse of opioids since 2000 that has had impacts for the health care, criminal justice, and child welfare systems. After more than a decade of declines in out-of-home care placements, the increases in the last half of this decade may be attributed to parental misuse of opioids. While much is known about infants who are born drug exposed and the ramifications for child welfare practice and policy, less is known about children who grow up in homes with parental misuse of opioids. This study is a descriptive literature review that aims to provide child welfare practitioners with information on the behavioral and substance abuse outcomes for older children and youth who live with parents who have an opioid use disorder. Implications of this body of research may aid in developing appropriate assessment and intervention tools for youth who present for services from opioid-involved homes.

The current study analyzes a sample of questions about drugs asked online by youth who participated in the National Institute on Drug Abuse’s (NIDA) “Drug Facts Chat Day.” The types of drugs youth asked about were coded into 17 substance categories, and the topics they raised were coded into seven thematic categories. The top five queried drugs were marijuana (16.4%), alcohol (8.5%), tobacco (6%), cocaine (5.7), and pharmaceutical drugs (4.5%). The effects of drug use, experience of being high, the addictiveness of drugs, pharmacology, and drug sales were among the more common types of questions to emerge but varied depending on the substance. These findings show the types of information young people are seeking about drugs and have clear implications to inform youth drug education programs.

Objective Prescription drug diversion, the transfer of prescription drugs from lawful to unlawful channels for distribution or use, is a problem in the United States. Despite the pervasiveness of diversion, there are gaps in the literature regarding characteristics of individuals who participate in the illicit trade of prescription drugs. This study examines a range of predictors (e.g., demographics, prescription insurance coverage, perceived risk associated with prescription drug diversion) of membership in three distinct diverter groups: individuals who illicitly acquire prescription drugs, those who redistribute them, and those who engage in both behaviors. Methods Data were drawn from a cross-sectional Internet study (N = 846) of prescription drug use and diversion patterns in New York City, South Florida, and Washington, D.C.. Participants were classified into diversion categories based on their self-reported involvement in the trade of prescription drugs. Group differences in background characteristics of diverter groups were assessed by Chi-Square tests and followed up with multivariate logistic regressions. Results While individuals in all diversion groups were more likely to be younger and have a licit prescription for any of the assessed drugs in the past year than those who did not divert, individuals who both acquire and redistribute are more likely to live in New York City, not have prescription insurance coverage, and perceive fewer legal risks of prescription drug diversion. Conclusion Findings suggest that predictive characteristics vary according to diverter group.

Community pharmacies selling potentially harmful products may contradict their role in health promotion. From a spatial analysis perspective, this study investigated the sale of alcohol, tobacco, and lottery tickets by community pharmacies in Passaic County, New Jersey, and assessed the relationship between sociodemographic factors of community residents and their potential accessibility to those community pharmacies. A mixed geographically weighted regression analysis revealed that census block groups with higher median household income tend to have less accessibility to pharmacies that sell addictive products. Relationships between Latino population and those pharmacies are mixed. No significant relationship was found for African American population.

Purpose: We focus on a little-researched issue how human immunodeficiency virus (HIV) epidemics and programs in key populations in metropolitan areas affect epidemics in other key populations. We consider (1) How are earlier epidemics among people who inject drugs (PWID) and men who have sex with men (MSM) related to later AIDS incidence and mortality among heterosexuals?; (2) Were prevention programs targeting PWID or MSM associated with lower AIDS incidence and mortality among heterosexuals?; and (3) Was the size of the potential bridge population of noninjecting drug users (NIDUs) in a metropolitan area associated with later AIDS incidence and mortality among heterosexuals?Methods: Using data for 96 large U.S. metropolitan areas, Poisson regression assessed associations of population prevalences of HIV-infected PWID and MSM (1992); NIDU population prevalence (1992-1994); drug use treatment coverage for PWID (1993); HIV counseling and testing coverage for MSM and for PWID (1992); and syringe exchange presence (2000) with CDC data on AIDS incidence and mortality among heterosexuals in 2006-2008, with appropriate socioeconomic controls.Results: Population density of HIV+ PWID and of NIDUs were positively related, and prevention programs for PWID negatively related to later AIDS incidence among heterosexuals and later mortality among heterosexuals living with AIDS. HIV+ MSM population density and prevention programs for MSM were not associated with these outcomes.Conclusions: Efforts to reduce HIV transmission among PWID and NIDUs may reduce AIDS and AIDS-related mortality among heterosexuals. More research is needed at metropolitan area, network, and individual levels into HIV bridging across key populations and how interventions in one key population affect HIV epidemics in other key populations. (C) 2014 Elsevier Inc. All rights reserved.