Testing Implementation Strategies to Scale-up a Multicomponent Continuum of Service Intervention for Families Involved in Systems with Parental Opioid and Methamphetamine Use

About This Grant

PROJECT SUMMARY/ABSTRACT Nationwide, 2023 saw a 9.5% increase in reports to child welfare (CW), with the majority related to parent drug use. This was notably true in Oregon, where the increase in the number of reports exceeded 13%. While 2024 saw an overall decrease in predicted annual overdose deaths nationally, Oregon’s predicted rate increased to a record high. Parents referred to CW experience a range of system interventions across the sequential intercept model, from diversion to preventive services, to child removal into foster care, and reunification and community monitoring. Along this intercept, parents are referred for services, including substance use and mental health treatment, parent training, and other social determinant of health needs. Families living in rural counties with limited treatment options experience myriad barriers to accessing treatment and exiting the system. Just Care for Families (JCFF) is an emerging practice for parents intersecting with CW developed to address their interrelated substance use, mental health, parenting, community building, navigating systems, and basic treatment needs. JCFF has been implemented in five rural Oregon counties with the opportunity to expand into others. Current implementation challenges, including travel distance in large rural counties and lack of a JCFF Expert workforce to support implementation, limit JCFF’s current scalability. This Hybrid Type II effectiveness-implementation trial uses an adaptation of a stepped-wedge design to test clinical outcomes spanning interception points with the CW system and implementation outcomes when JCFF is delivered with the addition of a mobile App with provider feedback about parent App usage. Nine rural Oregon counties, five active counties previously implemented with developer support, and four new counties that will implement with new JCFF Expert support have been recruited to test the (Aim 1) clinical effectiveness of JCFF when delivered with and without the App. A total of 254 parents with opioid and/or methamphetamine use and intersection with the CW system will be recruited to participate. Parents will receive usual services, JCFF, JCFF with the App, or JCFF with the App and feedback. Longitudinal in-person assessments at baseline, 4-months, 9-months, 14-months, and 18-months, and weekly text assessments of social determinants of health needs and CW intersection will test the overarching primary aim of reduction in parent opioid and methamphetamine use over time with increased treatment engagement, retention, completion and decreased length of CW case, re- entry into treatment, and recidivism (arrest, CW re-referral). The (Aim 2) effectiveness of the JCFF implementation approach will be tested when implemented with the support of new JCFF Experts versus developer Experts, with the aim of equal effectiveness. Clinical and implementation outcomes will be modeled (Aim 3) to examine the impact that adding the App could have on program sustainment for rural programs, expanding the potential for JCFF to scale up in Oregon and elsewhere, positioning for public health impact.