Drug use trends change rapidly among youth, leaving intervention experts struggling to respond to emerging drugs promptly. We have a critical need to advance implementation strategies to optimize system responsiveness to these emerging issues. COVID-19 has increased the urgency for implementation science to facilitate rapid, equitable responses using existing treatment and prevention efforts. Tier 1 evidence-based interventions (EBIs), such as the Michigan Model for HealthTM (MMH) lend themselves to addressing emerging trends. Our overall objectives are to 1) Improve the responsiveness of school-based EBIs in addressing urgent issues and 2) Find ways to support teachers in implementing updated EBIs, attending to unique considerations of low-resource schools. We will use After Action Review (AAR), to guide the systematic design of RAPD, Rapid Adaptation to Prevent Drug use, a novel bundle of implementation strategies. AAR is a reflective process focused on improving public health systems’ rapid response capacity. Key phases of AAR include: 1) Objective observation; 2) Analyze gaps/best practices, 3) Identify and test suitable implementation strategies to improve responsiveness to the next event (e.g., COVID-related drug use escalation). Sustainable strategies are central to achieving our objectives. Thus, we will also conduct a preliminary stakeholder-focused cost analysis. The rationale for this research is that designing and testing RAPD will enhance schools’ capacity to respond to urgent drug issues sustainably, and provide up-to-date, relevant resources for effective and equitable prevention. The proposed research will address the following aims: Aim 1: Identify implementation gaps and best practices in responding to urgent drug use events. We will use AAR to review the statewide response to the vaping crisis using the MMH using rapid qualitative analysis and identify gaps to be addressed with RAPD. Aim 2: Design and pilot test RAPD implementation and effectiveness. We will design a RAPD to optimize responses to urgent drug use events and pilot test in schools serving low-income students to assess equity. We will assess implementation outcomes using a convergent mixed methods design, and effectiveness via a group RCT comparing RAPD and standard MMH implementation. Aim 3: Assess costs and benefits of RAPD from multiple stakeholder perspectives. We will use an exploratory sequential mixed methods design to understand and identify key costs and outcomes from key stakeholder perspectives. We will develop a costing guide and conduct a preliminary cost analysis to inform an economic evaluation for a larger trial. The proposed research is innovative because to date implementation strategies have not been designed to support systems in responding to changing public health trends with attention to equity. In addition, this study focuses on implementation strategies to reduce the health impact of emerging drugs and provide an infrastructure to make future adaptations that can be applied in other contexts. The proposed research is significant because it will advance applying implementation science to achieve access, cost and equity for drug use prevention.

This is a novel study focused on designing and testing an implementation strategy bundle, Rapid Adaptation to Prevent Drug use (RAPD). RAPD will help optimize the capacity of schools respond to emerging drug use issues by reflecting on gaps and best practices from previous responses (e.g., vaping), including inequities in responsiveness. This research will enhance the public health impact of existing evidence-based interventions, enhance equity and enable similar adaptations of future emerging drug use issues.