Recovery Management Checkup Scalability and Sustainability (RMC-SS) Hybrid Experiment: Evaluating Comparability of Client and Implementation Outcomes in Community Organizations Post-Arrest

Abstract Individuals who are involved in the criminal justice system are at high risk of drug-related overdose; they also face barriers to engaging in substance use disorder (SUD) treatment and recovery support services. Recovery Management Checkups (RMC) is an evidence-based intervention for linking individuals to treatment and recovery services and providing ongoing recovery support based on a public health model of chronic disease management. RMC uses a structured, motivational-interviewing based protocol delivered by linkage managers through regular check-ups. Chestnut Health Systems proposes a hybrid type 2 effectiveness-implementation trial guided by the Exploration, Preparation, Implementation, and Sustainability (EPIS) framework that will: 1) integrate RMC in community-based programs in four discrete areas in Chicago with the highest risk of substance-related fatality and arrest, and 2) test the equivalence of client and implementation outcomes for RMC delivered by staff in community programs versus Chestnut research staff. Study collaborators include Cook County Sheriff, SUD treatment providers, and community-based service programs (RMC Adopters); a Community Advisory Board of stakeholders will provide input through all study phases. Approximately 150 people who report using opioids, stimulants, and/or alcohol at least weekly in the past 90 days will be recruited from each target area, between their arrest and first court appearance. Study participants will be randomly assigned at a 2:1 ratio to receive RMC from either an RMC Adopter or from Chestnut research staff. A multi- component external facilitation strategy will be used to implement RMC at the four RMC Adopter sites. This strategy will provide equivalent training and support to RMC Adopters with that received by Chestnut research staff through virtual training, automated decision supports, and Artificial Intelligence-based tools. Across study arms, RMC will be delivered at enrollment and months 1, 3, 6, and 9; interviews will be conducted at enrollment and months 1, 3, 6, 9, and 12 to assess client outcomes. Implementation processes and outcomes will be tracked through facilitation interactions, site visits, staff surveys, and qualitative interviews. The study has the following specific aims: Aim 1. Evaluate the equivalence of RMC provided by community organizations and research teams on: 1a) days of any SUD treatment (primary outcome); 1b) structural equation modeling invariance of effects on SUD intervention dose (medication, SUD treatment, mutual-help group, overdose prevention), public health outcomes (substance use, SUD symptoms, overdose, risk behaviors), and public safety outcomes (types of crimes, days of illegal activity). Aim 2. Assess the impact of the facilitation-based strategies in supporting RMC integration across three implementation phases, including analytical sub-aims to identify: 2a) how pre-implementation and implementation-phase strategies impacted final site fidelity scores; 2b) the impact of duration of implementation phases and proportion of activities completed on RMC Adopter’s ability and time to reach competency; and 2c) organizational-level determinants of RMC sustainment plan. This study is part of the NIH’s Helping to End Addiction Long-term (HEAL) initiative to speed scientific solutions to the national opioid public health crisis. The NIH HEAL Initiative bolsters research across NIH to improve treatment for opioid misuse and addiction.