A cluster randomized trial of an organizational linkage intervention for offenders with substance use disorders: study protocol

Abstract

BackgroundSubstance use disorders are highly prevalent in community correctional populations, yet these settings frequently are ill-equipped to identify and refer offenders to community-based treatment services. In particular, community corrections staff are often opposed to the use of medication in addiction treatment because of inadequate knowledge, resources, and organizational structures to facilitate client linkages to evidence-based services.Methods/designEach of the NIDA-funded Research Centers recruited 2 criminal justice agencies to participate in the study. Eligibility rules required study sites that were focused on community corrections (i.e., probation or parole), had few or no formal relationships with treatment providers for referring clients to medication-assisted treatment, and had no state or local policies prohibiting such relationships. Sites under the oversight of the same parent agency were eligible only if they were in geographically distinct catchment areas, and could be assigned to different study arms without cross-contamination at any level. The 18 clusters consisted of community corrections officers and their offender caseloads nested within agencies, each of which was partnered with at least one community-based substance abuse treatment program. Randomization was blocked by Research Center, within which one cluster was randomly assigned to a training-only condition (comparison) and the other to training followed by a strategic organizational linkage process (intervention). Line staff received a scientifically-grounded, systematically-delivered training session that addresses gaps in existing knowledge, perceptions, and information about medication-assisted treatment (MAT) and local availability of MAT services. Key decision-makers subsequently were asked to collaborate in a strategic planning process to enhance formal and informal linkages between criminal justice agencies and local MAT providers. It was hypothesized that the two implementation intervention components together would be more likely than staff training alone to improve the process of referring opioid- and alcohol-dependent adults under community supervision to appropriate addiction pharmacotherapy. Outcomes were measured at the client (referrals), line staff (attitudes), and organizational (linkage) levels.DiscussionThrough closer collaboration among criminal justice agencies and treatment providers, improved linkages to effective substance abuse treatment should yield significant clinical, public health and public safety benefits.

Community Correctional Agents’ Views of Medication-Assisted Treatment: Examining Their Influence on Treatment Referrals and Community Supervision Practices

“…The Medication Assisted Treatment Implementation in Community Correctional Environments (MATICCE) study 16 was a multi-site cluster randomized study comparing two implementation strategies that addressed separate barriers to increasing access and referrals to MAT already available in the community. 16 An organizational linkage intervention was used to target inter- and intra-organizational barriers that were specific to localized sites, and a training designed to improve knowledge, attitudes, and information about MAT was used to target community correctional agents, the individuals believed to be directly responsible for MAT referrals.…”

Effects of an Organizational Linkage Intervention on Inter-Organizational Service Coordination Between Probation/Parole Agencies and Community Treatment Providers

“…The MATICCE study involved nine research centers (for further details, see Friedmann et al 2013). Each Research Center collaborated with two or more probation/parole agencies located in divergent geographic catchment areas.…”

“…For both cohorts, 3-level HLM models were examined with random effects estimated for research center (Level 3) and site (Level 2). 2 Minimum detectable effect size (MDES) was calculated for a 3-level MSCRT (Spybrook and Raudenbush 2009); there was at least 80 % power to detect a true population effect as small as 0.37, corresponding to a medium-small effect size (see Friedmann et al 2013). …”

“…Implementation activities were all manualized, the progress of each site was monitored through monthly and phase reports, and there was a good deal of similarity in the strategic goals implemented across sites (Friedmann et al 2013). It is still possible, however, that some variation in implementation occurred across sites and across phases of the intervention.…”

“…Many individuals with mental health needs or substance use disorders are under the supervision of community corrections. Treatment services, however, particularly medication-assisted treatment (MAT) for opioid and alcohol dependence, are rarely delivered by correctional staff (Friedmann et al 2012, 2013). Rather, receipt of treatment services typically requires that individuals be referred to treatment providers in the community.…”