PROJECT SUMMARY/ABSTRACT Over the last 5 years, many states across the country have experienced an increase in children involved in the foster care system as a result of young parental opioid and methamphetamine misuse and disorder. In 2017, the child welfare system received 4.1 million referrals for approximately 7.5 million children, with parental drug abuse and child neglect accounting for the large majority of cases. This is particularly true in Oregon, where over 55% of cases involve parents under the age of 30, and over 60% of cases in the foster care system are associated with parental drug abuse. The Families Actively Improving Relationships (FAIR) program is a recently developed, rigorously evaluated, intensive outpatient treatment program for parents involved in the child welfare system for parental opioid and/or amphetamine type substance use disorder–methamphetamine (OUD; MUD). Outcomes from the FAIR effectiveness trial suggest the potential for FAIR to be adapted as a prevention program for parents involved with child welfare and self-sufficiency systems, and to be implemented in counties with low service availability and access. This UG3/UH3 exploratory-developmental phased project dedicates a year of activities toward collaborating with Oregon state Department of Human Services (DHS) partners and leadership to develop a plan for adaptation, recruitment, and implementation of FAIR for prevention. During the UG3 phase, the investigative team—with expertise in intervention development and clinical effectiveness trials, implementation science, decision science, health economics, and including DHS leadership—will work in collaboration with the Coordinating Center to (UG3 Aim 1) Develop strategies to identify, reach, and engage parents involved in the DHS system, aged 16 to 30, who are at-risk for escalation of misuse or development of OUD and/or MUD; and (UG3 Aim 2) Develop and adapt FAIR to prevent initiation of opioid and/or methamphetamine misuse and escalation to disorder. Following the completion of a set of concrete milestones during the first year, the UGH phase of the project will conduct a Hybrid I randomized clinical trial, to evaluate the adapted FAIR program and its implementation. Across two counties, parents referred by DHS for opioid or methamphetamine use or misuse with risk for escalation (n = 240), will be recruited and followed longitudinally for 24 months. Parents will be randomized to receive the adapted FAIR as prevention, or standard case management and referral (STAND). Overarching goals of this phase are to test the effectiveness of the adaptations designed in the UG3 phase and to build upon state collaborations— specifically, to: (UH3 Aim 1) Evaluate the effectiveness of FAIR in preventing DHS-involved parents, aged 16 to 30, from initiating misuse or escalating opioid and/or methamphetamine use; (UH3 Aim 2) Examine and assess the implementation of FAIR in the county-driven DHS system to inform sustainability plans; and (UH3 Aim 3) Assess the implementation and intervention costs associated with the adoption of FAIR. Outcomes from this project will inform further refinement of protocols and the potential for broader scale-up of FAIR.

PROJECT NARRATIVE Rates of opioid and methamphetamine misuse and disorder in young parents involved in the Department of Human Services child welfare and self-sufficiency systems are staggering. In Oregon, there is a strong correlation between parental overdose and child entry into foster care. The FAIR program, a rigorously evaluated, outpatient treatment program for the treatment of child welfare-involved parents with substance use, will be adapted for prevention in Oregon and evaluated for potential broader scale-up, creating the opportunity for a significant public health impact for parents aged 16 to 30, their children, and the systems in which they are embedded.