Community-based Substance Use Research Articles

A randomized controlled trial of a virtual community-based mental health and substance use program in the Philippines

Purpose This study aims to evaluate the delivery of a virtual community-based mental health and substance use program for Filipino drug users during the COVID-19 pandemic. Design/methodology/approach It used a randomized control longitudinal design with data collected prior to the program and every two months for 10 months. The programs focused on building recovery skills, life skills and family modules. Program length ranged from a brief intervention of three sessions to 24 sessions depending on whether clients were low risk, moderate risk or those arrested for drug use. Findings Results revealed significant improvements in recovery skills of participants in the treatment group compared to those in the control group. Mental health illness symptoms decreased for both control and treatment groups; however, no differences were found in recovery capital and cravings. Research limitations/implications The lack of significant changes in certain variables, such as recovery capital, requires more data to understand the barriers to enable greater recovery. The study was limited to virtual delivery of rehabilitation services conducted during the COVID-19 pandemic. Future studies may wish to compare modalities of online and onsite delivery to enable a comparison of effectiveness. Practical implications Results suggest the feasibility of virtual delivery of mental health and substance use treatment implemented by trained paraprofessionals. However, it also highlights the necessity to build the capacity of service providers and address connectivity challenges. Social implications Stigma and discrimination prevent people who use drugs from seeking treatment. Virtual delivery of mental health and substance use treatment can provide a platform where people can seek help while maintaining some privacy. Originality/value The study provides evidence from under-represented populations – persons who use drugs in the Philippines.

Linking Community-based Substance Use Disorder Treatment to Health Administrative Data: understanding vulnerable populations.

IntroductionMost substance use disorder (SUD) treatment occurs in community settings. Community-based SUD treatment information is rarely captured or utilized. The objective of this study was to examine the efficiency of a data linkage of community-based SUD treatment to health administrative data holdings in Ontario, Canada, and to describe sociodemographic and clinical characteristics of individuals accessing SUD services. MethodsData from community-based SUD service providers (>180) from April 2015 to March 2022 were linked to administrative data holdings at ICES. Linkage rates were evaluated. Sociodemographic (age, sex, neighbourhood-level income) and clinical (substance use, physician visits, Emergency Department (ED) visits and hospitalizations) characteristics were evaluated. ResultsThe linkage rate of DATIS ICES data holdings was >92% for all years (2015-2022). Of the 234,501 individuals admitted to a DATIS program, 36.1% were female, 46.2% were 25-44 years old, and 51.6% resided in the two lowest neighbourhood income quintiles. Alcohol (33.4%) was the most common substance identified. For outpatient care occurring within 1 year prior to admission, around 56.0% and 23.3% had Mental Health and Addictions (MHA) related primary care and psychiatrist visits, respectively. For acute health services, 29.8% and 14.2% had a MHA- related ED visit or hospitalization, respectively. DiscussionSUD treatment data from community settings can be successfully linked to other health administrative data. Individuals with SUD have a high rate of acute health care use, and a relatively low access to psychiatrists. SUD treatment data linkage should be used to understand how to optimize access to care for vulnerable individuals.

Quasi-randomized trial of solution-focused brief therapy intervention for readiness to change and alcohol and other drug use in a Brazilian community-based treatment center

Objective Strategies to increase readiness to change may enhance community-based substance use treatment outcomes. This study evaluated the effect of solution-focused brief therapy (SFBT) on readiness to change and substance use compared to treatment as usual (TAU) in a Brazilian community-based substance use treatment center. Methods One hundred two adults (M = 36.79, SD = 10.29) were quasi-randomized into SFBT or TAU groups. Assessments were completed at baseline, post-test, and 1-month follow-up. The primary outcome was the changes in readiness to change at post-test and 1-month follow-up. The secondary outcome was the change in substance use at 1-month follow-up. Results Through Quade non-parametric analysis of covariance (ANCOVA), both groups decreased tobacco, alcohol, and cocaine/crack use at 1-month follow-up, but SFBT had greater reductions in alcohol use (p = .05). ANCOVA analysis demonstrated no differences between groups on readiness to change at any time point. However, among participants who used multiple substances (n = 59), SFBT showed higher readiness to change at post-test (p = .05). Conclusions These findings strengthen the evidence that SFBT holds promise for positive community-based substance use treatment outcomes.

Perceptions of Community Corrections and Treatment Experience: A Qualitative Study Among People With Incarceration Histories Receiving Outpatient Methadone Treatment.

Community correctional experiences among individuals receiving methadone treatment (MT) for opioid use disorder (OUD) are poorly understood. We qualitatively investigated perceptions of community corrections and treatment experiences among individuals with criminal-legal system experience currently receiving outpatient MT. From January to December 2017, we recruited 42 individuals with history of criminal-legal system involvement enrolled in outpatient MT at a low-barrier nonprofit organization operating multiple clinics in Connecticut. An experienced qualitative research team conducted one-to-one, in-person, semistructured interviews about incarceration and treatment experiences with individuals receiving MT. Participants completed a demographics survey. The interviews were audiorecorded, transcribed, de-identified, and independently coded using NVivo. Participants described the community corrections system as restrictive and abstinence-focused. Most participants described positive perceptions of and experiences with community corrections officers (CCOs), yet described negative perceptions of and experiences with the community corrections system overall. Participants perceived CCOs to have limited knowledge of OUD and MT. Participants described a range of CCO judgment toward their OUD, with some appearing understanding and nonjudgmental while others were perceived to have stigma and prejudice. Few participants noted assistance from CCOs with seeking MT or community-based substance use disorder care. Some participants desired improved treatment facilitation, but viewed forced or coercive treatment negatively. To our knowledge, this is the first qualitative study to examine community corrections experience among people receiving outpatient medication for OUD. While individuals receiving MT have negative experiences with the community corrections system, they perceive individual CCOs positively. Interventions addressing gaps in CCOs knowledge of OUD and MT are needed to optimize support for individuals on probation or parole with OUD. Provision of OUD treatment facilitation appears desirable to some individuals in community supervision.

Rural and urban clinician views on COVID-19’s impact on substance use treatment for individuals on community supervision in Kentucky

BackgroundThe COVID-19 pandemic produced system-level changes within the criminal legal system and community-based substance use disorder (SUD) treatment system with impacts on recovery efforts. This study examines rural and urban clinicians’ perspectives of COVID-19 on SUD treatment delivery for people on community supervision.MethodsVirtual qualitative interviews were conducted between April and October 2020 with 25 community supervision clinicians employed by Kentucky’s Department of Corrections (DOC), who conduct assessments and facilitate community-based treatment linkages for individuals on probation or parole. Transcripts were analyzed in NVivo using directed content analysis methods.ResultsClinicians were predominantly white (92%) and female (88%) with an average of over 9 years working in the SUD treatment field and 4.6 years in their current job. Four COVID-19 themes were identified by both rural and urban clinicians including: (1) telehealth increases the modes of communication, but (2) also creates paperwork and technological challenges, (3) telehealth requires more effort for inter/intra-agency collaboration, and (4) it limits client information (e.g., no urine drug screens). Two additional rural-specific themes emerged related to COVID-19: (5) increasing telehealth options removes SUD treatment transportation barriers and (6) requires flexibility with programmatic requirements for rural clients.ConclusionsFindings indicate the need for community-based SUD treatment providers approved or contracted by DOC to support and train clients to access technology and improve information-sharing with community supervision officers. A positive lesson learned from COVID-19 transitions was a reduction in costly travel for rural clients, allowing for greater engagement and treatment adherence. Telehealth should continue to be included within the SUD continuum of care, especially to promote equitable services for individuals from rural areas.

Prevalence and factors associated with polydrug use among clients seeking treatment for alcohol misuse.

The aim of this paper was to examine the client and psychosocial characteristics associated with polydrug use in patients with alcohol misuse as their primary drug of concern (PDC) seeking treatment from substance use treatment centres. Self-report surveys were undertaken with clients attending 1 of 34 community-based substance use treatment centres across Australia with alcohol as their PDC. Survey items included client's socio-demographic characteristics, level of alcohol dependence, use of other drugs including tobacco, health and wellbeing factors including health-related quality of life. The factors associated with polydrug use (alcohol use concurrent with at least one other drug) were examined. In a sample of 1130 clients seeking treatment primarily for alcohol problems, 71% reported also using another drug. The most frequently used drug was tobacco (50%) followed by cannabis (21%) and benzodiazepines (15%). Excluding tobacco use, 35% of participants reported polydrug use. Factors associated with any polydrug use were younger age, lower education levels, lower levels of mental health related quality of life and housing risk (i.e., risk of eviction or experienced homelessness in past 4 weeks). When tobacco was excluded, factors associated with polydrug use were age, lower physical and mental health-related quality of life, and housing risk. Most adults seeking treatment for alcohol misuse as their PDC reported using another drug in addition to alcohol. Treatment services should be designed accordingly to maximise the likelihood of treatment engagement and success.

Operational status of mental health, substance use, and problem gambling services: A system-level snapshot two years into the COVID-19 pandemic.

The aim of this paper is to provide a system-level snapshot of the operational status of mental health, substance use, and problem gambling services 2years into the pandemic in Ontario, Canada, with a specific focus on services that target individuals experiencing vulnerable circumstances (e.g., homelessness and legal issues). We examined data from 6038 publicly funded community services that provide mental health, substance use, and problem gambling services in Ontario. We used descriptive statistics to describe counts and percentages by service type and specialisation of service delivery. We generated cross-tabulations to analyse the relationship between the service status and service type for each target population group. As of March 2022, 38.4% (n=2321) of services were fully operational, including 36.0% (n=1492) of mental health, 44.1% (n=1037) ofsubstance use, and 23.4% (n=78) of problem gambling services. These service disruptions were also apparent among services tailored to sexual/gender identity (women/girls, men/boys, 2SLGBTQQIA+individuals), individuals with legal issues, with acquired brain injury, and those experiencing homelessness. Accessible community-based mental health, substance use and problem gambling services are critical supports, particularly for communities that have historically contended with higher needs and greater barriers to care relative to the general population. We discuss the public health implications of the findings for the ongoing pandemic response and future emergency preparedness planning for community-based mental health, substance use and problem gambling services.

Juvenile probation officer perception of contingency management to target caregiver engagement and training outcomes

Few community-based substance use treatment programs are available or skilled in treating justice-involved youth, highlighting the need to equip juvenile probation officers with the skills to deliver evidence-based substance use treatment. Contingency management (CM) is evidence-based for treating substance use and shows promise for juvenile probation officers’ successful uptake (positive opinions and trainability). However, research has not examined whether probation officers’ positive beliefs and trainability generalize to target behaviors beyond those displayed by youth, but that nevertheless affect youth outcomes. This study examined probation officers’ perceptions of using CM to engage caregivers and assessed probation officers’ CM knowledge and CM delivery after training in a protocol-specific CM program for caregivers of substance-using youth on probation. Results showed probation officers were ambivalent about CM for caregivers. Results also showed that age, training format and how competency is assessed may be essential to consider. Implications for the dissemination of CM and future research are discussed.

Efficient and effective measurement of provider competence in community-based substance use treatment settings: Performance of the Motivational Interviewing Coach Rating Scale (MI-CRS)

ObjectiveEfficient and effective fidelity measurement is necessary to improve rigor and reduce burden of motivational interviewing (MI) implementation studies for both fidelity outcomes and quality improvement strategies. This article reports on such a measure developed with rigorous methodology and tested in community-based substance abuse treatment settings. MethodsThis scale development study analyzed data from a National Institute on Drug Abuse study testing the Leadership and Organizational Change for Implementation (LOCI) strategy. Utilizing item response theory (IRT) methods and Rasch modeling, we analyzed coded recordings (N = 1089) of intervention sessions of 238 providers from 60 substance use treatment clinics across nine agencies in an implementation trial focusing on MI. ResultsThese methods yielded a reliable and valid 12-item scale representing single construct dimensionality, strong item-session maps, good rating scale functionality, and item fit. Separation reliability and absolute agreement for adjacent categories was high. No items were significantly misfitting, though one was borderline. The LOCI community providers were less likely to be scored in the advanced competence range and items were more difficult compared to the original development sample. ConclusionsThe 12-item Motivational Interviewing Coach Rating Scale (MI-CRS) showed excellent performance in a large sample of community-based substance use treatment providers using real recordings. The MI-CRS is the first efficient and effective fidelity measure appropriate for diverse ethnic groups, with interventions that are MI only or interventions that integrate MI with other treatments, and with adolescents and adults. Follow-up coaching by trained supervisors may be needed for community-based providers to achieve the highest level of MI competence.

Individual factors predict substance use treatment course patterns among patients in community-based substance use disorder treatment.

Substance use disorders (SUDs) usually involve a complex natural trajectory of recovery alternating with symptom reoccurrence. This study examined treatment course patterns over time in a community SUD clinic. We examined depressive symptoms level, primary SUD assigned at each admission, and lifetime misuse of multiple substances as potential risk factors for premature treatment termination and subsequent treatment readmission. De-identified longitudinal data were extracted from charts of 542 patients from an SUD treatment center. Survival analysis methods were applied to predict two time-to-event outcomes: premature treatment termination and treatment readmission. Primary opioid (vs alcohol) use disorder diagnosis at admission was associated with higher hazard of premature termination (HR = 1.91, p<0.001). The interaction between depressive symptoms level and substance use status (multiple vs single use) on treatment readmission was significant (p = 0.024), such that higher depressive symptoms level was predictive of readmission only among those with a history of single substance use (marginally significant effect). Lifetime use of multiple (vs single) substances (HR = 1.55, p = 0.002) and age (HR = 1.01, p = 0.019) predicted increased hazard of readmission. Findings did not support a universal role for depressive symptoms level in treatment course patterns. Primary SUD diagnosis, age, and history of substance misuse can be easily assessed and incorporated into treatment planning to support SUD patients and families. This study is the first to our knowledge that afforded a stringent test of these relationships and their interactions in a time-dependent, recurrent event, competing risks survival analysis examining both termination and readmission patterns utilizing a real-world clinic-based sample.

Effects of a community-based substance use prevention program in Iranian adolescents (SUPPIA)-using social cognitive theory

ABSTRACT Objective This study aimed to develop and assess a tailored community-based intervention protocol for preventing substance use based on social cognitive theory in adolescents. Methods A tailored community-based substance use prevention intervention was undertaken with 140 boys and girls (14-18- years old) participating in the study in Isfahan, Iran. The intervention group attended eight 45-minute theory-based sessions based on social cognitive theory from 2018 to 2020. Data were analyzed 6, 18, and 24 months later by the SPSS.23 software. Results Social cognitive theory indicators, including positive outcome expectancies (p < .001, F = 25, ES = 0.34), negative outcomes expectancies (p < .001, F = 31.2, ES = 0.38), and self-efficacy (p < .001, F = 12.3, ES = 0.45) showed significant improvements at three stages (6, 18, and 24 months after intervention). The program also demonstrated significant but low effect size reductions in the incidence of cigarette (ES = 0.15), alcohol (ES = 0.05), and other drug use (ES = 0.01) in the intervention group among three follow-ups. Conclusion The results support the effectiveness of the community-based intervention program based on social cognitive theory in reducing the incidence of substance use among Iranian adolescents.

Building engagement to support adoption of community-based substance use prevention initiatives

BackgroundSystem-level approaches that target social determinants of health are promising strategies to support substance use prevention, holistic youth development and wellbeing. Yet, the youth services system is largely based on individual-focused programs that do not adequately account for social determinants of health and place the responsibility for wellness on the individual. There is a need to understand how to enhance adoption of complex system-level approaches that support comprehensive youth development. The Icelandic Prevention Model (IPM) represents a collaborative initiative that takes an ecological, system-level approach to prevent substance use and promote wellness in youth. This research was designed to examine key stakeholder perceptions to better understand social motivations and contextual complexities that influence stakeholder support to garner community-level adoption of the IPM in a rural Canadian community.MethodsThis research applies a case study approach using qualitative interviews to explore strategies to support uptake in the early stages of IPM adoption associated with developing community buy-in and acceptance. A thematic analysis was applied using QSR NVivo.ResultsNine interviews were conducted with community partners leading the implementation of the IPM. Three over-arching themes emerged from the data: 1) Motivating influences 2) Strategies to develop buy-in, and 3) Resistance to the adoption of the IPM. Findings reflect issues that affect behaviour change in system transformation in general as well as upstream prevention and the IPM, in particular.ConclusionsThe findings from this research describe critical insight derived from implementing community-driven initiatives that are designed to support health promotion. It contributes new scientific knowledge related to implementation of complex system-level innovations and practical information that is useful for communities interested in implementing the IPM or following similar approaches to prevent substance use.

Community-Based Mental Health and Substance Use Services for People Leaving Prison: Equity and Inclusion Strengths and Limitations in Specialized Service Inventory Development.

Community reentry from prison is a challenging process, especially for persons with lived and living experience of mental health concerns. Access to appropriate community-based care for those leaving prison is a key part of improving health equity for this population. Our work to develop a cross-Canada inventory of active community mental health and substance use services for criminal justice-involved persons represents a valuable example for others hoping to conduct projects that are similar in nature and scope. We describe the strengths and limitations of our health equity-informed, multi-pronged approach to service inventory development, highlighting the importance of considering and addressing search- and stakeholder-related biases. Investment of time and resources is critical to ensuring comprehensive and inclusive identification of community-based mental health services and meaningful resource development.

Developing a realist theory of community-based residential substance use treatment

Community-based residential treatments for substance use disorders (SUDs) have mixed effectiveness, which has been hypothesized to be due to the variability of program offerings across treatments. Therefore, the purpose of the present study was to develop a realist program theory of a community-based residential treatment centre to understand which components of treatment are most effective, who benefits from treatment, and why. The study was completed in collaboration with a community-based residential treatment program located in Canada. A realist evaluation was conducted using qualitative interviews (N = 27) with program stakeholders. Transcripts were analyzed using thematic analysis to identify Context-Mechanism-Outcome (CMO) configurations that create the program theory. The analysis identified an overarching organizational context and 11 CMO configurations that comprise the program theory. The CMOs were grouped into three themes (i.e. relational, psychological, and diversity), underscoring the multiple pathways in which recovery is achieved for individuals with SUDs. Across the themes, the importance of building peer recovery relationships, creating structure, and inter-agency collaborations were highlighted. The results of the present study offer a contribution to the literature in understanding how, why, and for whom community-based residential treatment for SUDs is effective while offering specific recommendations to best tailor treatments to individuals.

Association between contact with mental health and substance use services and reincarceration after release from prison.

ObjectivePeople released from prison who experience mental health and substance use problems are at high risk of reincarceration. This study aimed to examine the association between contact with mental health and substance use treatment services, and reincarceration, among adults released from prison.MethodsPre-release survey data from 1,115 adults released from prisons in Queensland, Australia were linked with administrative health and correctional records covering a median of 787 days post-release. We constructed marginal structural Cox proportional hazards models, adjusting for pre-release variables and time-varying indicators of emergent mental health and substance use problems, to examine the association between contact with mental health and substance use treatment services, and reincarceration.ResultsThe adjusted hazard ratio (AHR) for reincarceration associated with mental health service contact was 1.76 (95%CI 1.23,2.51). Among those not on parole following release, the AHR for reincarceration associated with substance use treatment service contact was 3.16 (95%CI 2.09,4.77); we found no evidence for an association among those who were released on parole (AHR = 1.07; 95%CI 0.80,1.43).ConclusionsAlthough we cannot eliminate the possibility of residual confounding, our findings suggest that infrequent or unsustained contact with community-based mental health and substance use treatment services is not protective against reincarceration, and may even be iatrogenic. Increased investment in high-quality and timely behavioural health services for people released from prison may simultaneously improve health outcomes, and reduce reincarceration.

Delivering Remote Measurement-Based Care in Community Addiction Treatment: Engagement and Usability Over a 6-Month Clinical Pilot.

ObjectiveMeasurement-based care (MBC) is an evidence-based practice in which patients routinely complete standardized measures throughout treatment to help monitor clinical progress and inform clinical decision-making. Despite its potential benefits, MBC is rarely used in community-based substance use disorder (SUD) treatment. In this pilot study, we evaluated the feasibility of incorporating a digital and remotely delivered MBC system into SUD treatment within a community setting by characterizing patients’ and clinicians’ engagement with and usability ratings toward the MBC system that was piloted.MethodsA pilot study was conducted with 30 patients receiving SUD treatment and eight clinicians providing SUD treatment in a large, publicly funded addiction and mental health treatment clinic. Services as usual within the clinic included individual psychotherapy, case management, group therapy, peer support, and medication management for mental health and SUD, including buprenorphine. Patients who enrolled in the pilot continued to receive services as usual and were automatically sent links to complete a 22-item questionnaire, called the weekly check-in, via text message or email weekly for 24 weeks. Results of the weekly check-in were summarized on a clinician-facing web-based dashboard. Engagement was characterized by calculating the mean number of weekly check-ins completed by patients and the mean number times clinicians logged into the MBC system. Ratings of the MBC system’s usability and clinical utility were provided by patients and clinicians.ResultsPatient participants (53.3% male, 56.7% white, 90% Medicaid enrolled) completed a mean of 20.60 weekly check-ins (i.e., 85.8% of the 24 expected per patient). All but one participating clinician with a patient enrolled in the study logged into the clinician-facing dashboard at least once, with an average of 12.20 logins per clinician. Patient and clinician ratings of usability and clinical utility were favorable: most patients agreed with statements that the weekly check-in was easy to navigate and aided self-reflection. All clinicians who completed usability questionnaires agreed with statements indicating that the dashboard was easy to navigate and that it provided meaningful information for SUD treatment.ConclusionsA digital and remotely delivered MBC system can yield high rates of patient and clinician engagement and high ratings of usability and clinical utility when added into SUD treatment as usual. The success of this clinical pilot may be attributable, in part, to the user-centered design processes that were used to develop and refine the MBC system that was piloted. Future efforts may focus on strategies to test whether MBC can be sustainably implemented and offers clinical benefits to patients in community SUD treatment settings.

Developing and implementing a community-based substance use prevention program in Iranian adolescents (SUPPIA): A study protocol

ABSTRACT Objective As substance use disorders are globally among the top causes of preventable mortality and morbidity among adolescents, there is a need for developing effective prevention programs to address the rising prevalence and the associated health consequences. The main aim of this study is to develop a community-based study protocol for preventing substance use in Iranian adolescents. Methods and results An ecological approach, mobilizing for action through planning and partnership (MAPP), was used to develop a study protocol for preventing substance use among 14–18-year-old adolescents participating in this study. Participants were randomized to the intervention (n = 70) or control (n = 70) groups. The intervention group was exposed to eight individual sessions by two qualified trainers over eight weeks to stimulate (1) positive outcome expectations, (2) self-efficacy, e.g., to resist social pressure, (3) self-regulation, e.g., by self-monitoring of stress and emotions. Outcomes were assessed by the percentage reduction in substance use after six, 18, and 24 months after the intervention. Discussion In this study, we have been to outline and explain the steps of developing and implementing a community-based study protocol. This protocol, if practical and effective, could be easily implemented in various settings and would reach large numbers of young people cost-effectively.

Adolescent substance use: Findings from a state-wide pilot parent education program

BackgroundAdolescent substance use has long been a top public health priority. In Indiana, concerning recent trends show high rates of youth alcohol consumption coupled with increasing use of opioids, synthetic marijuana, and over-the-counter drugs. Based on research indicating that parent-based prevention efforts may be a particularly effective way to target adolescent substance use, and in a direct effort to address Indiana’s 2017 Strategic Plan to Address Substance Use, we conducted an applied research study targeting parents’ knowledge regarding adolescent substance use in Indiana.MethodsThis community-based applied research study included: (i) a needs assessment of Indiana Extension Educators’ concerns regarding adolescent substance use, (ii) creation and dissemination of an evidence-informed parent education program on adolescent substance use in collaboration with Purdue Extension (a key community stakeholder), and (iii) qualitative focus group discussions at the end of each program that assessed the challenges families face regarding adolescent substance use, the types of information and resources they wish they had, and the usefulness of our program.ResultsThe needs assessment revealed that Indiana communities would most benefit from education regarding ways to spot and monitor substance use in teens, and strategies to communicate with teens about substance use. Additionally, Extension Educators thought that existing resources to tackle substance use largely did not match the needs of Indiana communities. Qualitative analysis of the focus group discussions across 8 pilot programs revealed five important themes: (1) The need for current, evidence-informed information regarding adolescent substance use among parents and youth-involved professionals in Indiana, (2) Concern regarding Indiana adolescents’ ease of access to substances and lack of healthy recreational activities, (3) Communicating with teens about substance use is crucial but difficult to implement, (4) Indiana communities’ need to prioritize funding for evidence-informed prevention programming, and (5) The need for community-based parent and caregiver support groups.ConclusionsOverall, the program was well-received and participants indicated that there was a strong need for this programming in their communities, but suggested collaborating with schools or similar local community stakeholders to increase attendance. Findings from this pilot study can inform future community-based adolescent substance use prevention efforts state-wide.

A Qualitative Study Exploring Access to Mental Health and Substance Use Support among Individuals Experiencing Homelessness during COVID-19.

People experiencing homelessness have higher rates of mental ill-health and substance use and lower access to health services compared to the general population. The COVID-19 pandemic led to changes in service delivery across health and social care services, with many adopting virtual or telephone support for service users. This paper explores the experiences of access to community-based mental health and substance use support for people experiencing homelessness during the COVID-19 pandemic. Qualitative telephone interviews were conducted with 10 women and 16 men (ages 25 to 71) who self-identified as experiencing homelessness in North East England between February and May 2021. With five individuals with lived experience, results were analysed using inductive reflexive thematic analysis. Reactive changes to support provision often led to inadvertent exclusion. Barriers to access included: physical locations, repetition of recovery stories, individual readiness, and limited availability. Participants suggested creating services reflective of need and opportunities for choice and empowerment. Community mental health and substance use support for people experiencing homelessness should ensure the support is personalised, responsive to need, inclusive, and trauma-informed. The findings of this research have important implications for mental health and substance use policy and practice for individuals who experience homelessness during a public health crisis.

Abstract P119: Conceptualizing Cultural Safety When Implementing A Community Based Substance Use Intervention Study Among Urban Native American Youth

Background: This study was conducted in the United States of America among Urban Native American (NA) youth attending two urban NA youth programs within the State of Florida. Aim: To culturally tailor the evidence-based Lowe (2016) Keetoowah-Cherokee Talking Circle intervention for substance use prevention among Keetoowah-Cherokee youth to that of an Urban Taking Circle (UTC) intervention for use among urban NA youth. Method: The integration of a culturally relevant theory, Native-Reliance, a community-based program approach, and cultural safety principles guided the intervention study method. The study implemented a 2-condition quasi experimental design and utilized convenience and snowball sampling methods for recruiting 100 urban NA youth as study participants. Participants originated from two urban NA community programs and were randomized by program site. Statistical analysis using multivariate analysis of variance (MANOVA) provided the means for determining if there were significant differences between the scores on measures at pre-intervention (baseline) and post-intervention. Results: Data findings indicated there is a direct relationship between the urban NA youth participants’ interests in engaging in drug use, alcohol consumption, and commercial tobacco smoking. However, additional findings provide evidence that a culturally based intervention was significantly more effective for the reduction of these substance use interests and general well-being than a non-culturally based intervention for urban NA youth. Conclusion: Study findings also indicated that supporting Urban NA youths’ utilization of urban NA values and beliefs promoted healthy behavior. Culturally safe interventions that support urban NA youth as a means in reducing harm associated with high-risk behaviors, such as substance use, is strongly recommended. Impact Statement: During each phase of the study, its method established assurance of cultural safety by operationalizing Native Reliance Theory. Therefore, an in-depth examination of the study methods with cultural safety principles is presented in context and warranted.