Project Summary The overarching goal of this Research Scientist Development Award (K01) is to provide Dr. Hannah Szlyk with the training and research activities needed to become an independent researcher who develops, tests, and implements cutting-edge digital therapeutic interventions that can promote health equity in recovery from opioid use disorder (OUD) plus commonly occurring mental disorders (COMD). This application outlines an integrated training and research plan that will provide Dr. Szlyk with the skills needed to achieve her career goal. Under the mentorship of experts in clinical trials, health equity, implementation science, user-centered design, and OUD research, Dr. Szlyk’s training will focus on the following key areas: (1) clinical trial methodology (Dr. Esther Lu; (2) implementation science and user-centered design (Drs. Patricia Cavazos-Rehg and Emily C. Williams); and (3) health equity in addictions and mental health (Dr. Darrell Hudson). Training in these three areas will be achieved through didactic and applied activities, participation in national conferences and institutes, and mentoring meetings. Dr. Szlyk will apply the skills acquired during the training activities to conduct a research project to appropriately adapt and test an mHealth intervention for Black Americans with OUD plus COMD. Rates of opioid-related deaths continue to rise among Black Americans in the United States. These deaths are often concentrated in medium-sized metropolitan cities, like St. Louis, Missouri, where this research is set. Yet, few interventions are developed to fit the unique needs of Black clients; none address their heightened overdose risk often compounded by COMD which decreases likelihood for recovery success. Also, Black individuals experience significant barriers to life saving OUD treatments, like medication for OUD (MOUD), because of structural racism. To address this gap, the K01 research project will integrate public health critical race praxis, implementation science, and user-centered design strategies to appropriately adapt an mHealth intervention for Black Americans with OUD plus COMD. The central hypothesis is that adaptations to the mHealth intervention will improve engagement and usability among Black participants, improve adherence to MOUD, and impact decreases in COMD. This research will address key gaps in treatment by 1) adapting an mHealth intervention for Black individuals with OUD plus COMD; 2) identifying barriers and facilitators to implementing an mHealth intervention among stakeholders who serve Blacks with OUD plus COMD; 3) examining the preliminary efficacy of an adapted mHealth intervention. These data will inform the design of a larger RCT for a future R01 application. Dr. Szlyk’s training and proposed research will be carried out in the outstanding intellectual environment of Washington University School of Medicine, which will provide her with a multitude of resources to meet her goals.

Project Narrative The opioid crisis has exponentially harmed Black Americans in the United States in recent years and this population continues to face significant barriers in access to appropriate treatment for opioid use disorder (OUD) and commonly occurring mental disorders (COMD). Recently the US Department of Health and Human Services’ Overdose Prevention Strategy acknowledged the importance of addressing the opioid overdose crisis through evidence-based treatment and recovery support - two essential elements of this proposal. This study aims to adapt and test the preliminary efficacy of a mobile Health intervention specifically tailored for Black Americans with OUD plus COMD.