Disrupting Social Risk Factors of Health to Improve Substance Use and Mental Health Outcomes for Parents in Rural Regions

Although social risk factors of health (SRFOH) have long been recognized as significant contributors to the quality of life and long-term outcomes for individuals, only recently have preventive intervention efforts begun to target negative risk factors directly as a method for achieving improved health outcomes. Little remains known about interventions that disrupt the ongoing negative effect of SRFOH or how to intervene on malleable factors (e.g., employment) in the context of less malleable factors (e.g., rural region). This application, Disrupting Social Risk Factors of Health to Improve Substance Use and Mental Health Outcomes for Parents in Rural Regions, is directly responsive to NIDA RFA DA-22-036 and seeks to test the multi-level, multi-component Just Care for Families ® (JCFF) intervention to prevent “opioid use disorder, and comorbid conditions by intervening” on social risk factors. Leveraging a naturally occurring roll out of JCFF across five rural Oregon counties, parents (N = 250) who are referred to JCFF will be recruited to participate. Oregon is the ideal setting for this project—data released in 2022 ranked the state as leading the nation in opioid and methamphetamine use, mental health disorders and suicide. Participating counties, though all rural, are distinct in their county health metrics, providing the opportunity to examine the influence of outside infrastructure conditions on intervention targets and subsequent prevention outcomes. Consenting parents will report weekly on their SRFOH needs for 18 months, regardless of whether they are engaged in services. When engaged, their JCFF clinician also will be probed weekly for a report of intervention strategies used to address SRFOH. Interventions will not be manipulated but will be observed as they naturally occur. Parents will be assessed for opioid and methamphetamine use, including IV drug use, and mental health symptoms, including suicide (ideation, intention, attempt) at Baseline, 9-months, and 18-months. To assess long-term prevention of IV drug use and suicide, administrative health data will be collected from the time of consent to 24-42 months post-Baseline. The intensive, longitudinal, sequencing design will allow an analysis of how JCFF components (Aim 1) disrupt individual and system-level risk factors and escalation of opioid and/or methamphetamine use and mental health disorders; (Aim 2) are impacted by external, infrastructure conditions; and (Aim 3) can influence the relationship between SRFOH and individual and system-level outcomes on costs, from the perspective of provider clinics. Outcomes will (a) inform the future scale-up of JCFF by providing an empirical basis for targeting and sequencing of parent SRFOH throughout the course of treatment, and the impact of these clinical decisions on outcomes and clinic-borne costs and (b) provide generalizable knowledge of the consequences of targeting, or not, negative SRFOH in the treatment of comorbid opioid and methamphetamine use and mental health disorders. The disruption of a parent’s negative SRFOH has the potential for a cascade of positive outcomes across generations and drive a significant improvement of public health.