Improving Treatment Together: a protocol for a multi-phase, community-based participatory, and co-design project to improve youth opioid treatment service experiences in British Columbia

Abstract

Background Opioid use is one of the most critical public health issues as highly potent opioids contribute to rising rates of accidental opioid-related toxicity deaths. This crisis has affected people from all age groups, including youth (ages 15–24) who are in a critical developmental period where the stakes of opioid use are especially high. Efforts to reduce the significant harms of opioid use have focused on the expansion of evidence-based treatments, including medications for opioid use disorder (e.g. buprenorphine). While these treatments are unequivocally life saving, recent evidence suggests that they may not align with youths’ needs. Accordingly, the ‘Improving Treatment Together’ (ITT) project has been designed with the aim to improve youths’ opioid treatment service experiences and outcomes by co-developing, implementing, and measuring youth-centred opioid use treatment service innovations. This manuscript describes the protocol for this multi-phase project. Methods The ITT project follows community-based participatory research (CBPR) and strategically integrates co-design processes throughout its four phases. Upon establishing a project partnership between national, provincial and community-based organizations, Phase 1 follows four core elements of human-centred co-design (empathy, needs identification, ideation, prototyping) in nine separate workshops. These workshops will be held in four diverse communities with youth, caregivers and service providers who have accessed or delivered opioid treatment services. Phase 1 will culminate in the co-production of opioid treatment service innovations to be considered by the project’s partners for further co-development, pilot testing, and wider implementation during the remaining phases of the project. Throughout each phase, the project will collect and analyse both qualitative and quantitative research and evaluation data to determine the project’s impact. Discussion This protocol provides a detailed description of the ITT project, with an emphasis on the project’s application of co-design and CBPR processes, the planned research and implementation procedures, and the establishment of a unique partnership. To our knowledge, this is one of the first projects to integrate these participatory processes to the design, implementation and measurement of youth-centred opioid treatment services. Embedding these processes throughout each phase of the project will strengthen the relevance and feasibility of the project’s service delivery innovations.

“We need to build a better bridge”: findings from a multi-site qualitative analysis of opportunities for improving opioid treatment services for youth

“…The ITT project follows a community-based participatory research (CBPR) approach [ 37 , 38 ] and integrates elements of human-centered co-design [ 39 , 40 ]. Further details about the project’s design and planned methods have been published elsewhere [ 35 ]. Briefly, the project is being conducted in British Columbia (BC) and Alberta (AB), two provinces in Canada that have been dramatically impacted by the opioid crisis [ 8 ].…”

“…The small group discussions were structured around the first two core elements of human-centered co-design: (1) empathy—aiming to understand youths’ experiences during their point-of-care interactions with opioid treatment services; and (2) identifying needs—aiming to articulate and prioritize the root problems or needs based on their experiences [ 35 , 49 , 50 ]. For both of these elements, participants spent the first 10–15 min individually reflecting on their experiences/needs using facilitation tools that are commonly used in human-centered design (e.g., Journey and/or Empathy Maps [ 35 ]). The facilitators then guided participants through a small group discussion for each topic (lasting approximately 1 h each).…”

“…As both CBPR and human-centered co-design are meant to adapt to local context and participant needs, several procedures were modified from the initial protocol [ 35 ] due to foreseen and unforeseen circumstances. The first workshop was done in the BC Interior Community (November 2019) and provided an opportunity to pilot and refine recruitment and data collection procedures.…”

“…For the remaining workshops, we engaged the project’s youth peer-researchers to enhance our outreach strategy. During this first workshop, we also piloted two facilitation tools commonly used in human-centered co-design—the Journey Map and Empathy Map [ 35 ]. The remaining three workshops used the Empathy Map only as it was less time consuming while prompting the most in-depth discussion.…”

“…To rectify this, it has been emphasized that the development of youth-centered interventions be co-designed with youth who are using opioids [ 18 , 33 , 34 ]. Accordingly, the ongoing multi-phase and multi-site ‘Improving Treatment Together’ (ITT) project [ 35 ] was designed to understand youths’ needs for improving opioid treatment services (Phase 1), and, subsequently, to co-design, implement, and test youth-centered innovations in opioid treatment services (Phase 2–4). The present manuscript reports on the Phase 1 qualitative findings with youth in two western Canadian provinces.…”