PROJECT SUMMARY Indiana ranks 13th nationally in drug overdose deaths and Hoosiers at risk for opioid misuse and other substance use disorders (SUDs) are unlikely to receive necessary services; Indiana - a largely rural state - ranks 46th in number of behavioral health treatment providers per individuals suffering addictions. By targeting rural counties in a Midwest state, our research team seeks to address the national opioid crisis at its epicenter. We will also focus on a population among those at greatest risk for opioid-related harms: youth involved in the juvenile justice system (YJJ). Among arrested youth, 78% have recently used illicit substances. Our research has shown that YJJ die at 1.5 times the rate of youth who have never been arrested, and a leading cause of YJJ death is drug overdose. The primary goal of our proposed project, Alliances to Disseminate Addiction Prevention and Treatment (ADAPT), is to address barriers to effective SUDs treatment of YJJ as identified by the substance use care cascade. We will accomplish our goal by creating a Learning Health (LHS) alliance between the juvenile justice system (JJ) and community mental health centers (CMHCs) in 8 rural Indiana counties. These collaborative JJ-CMHC partnerships will facilitate SUD risk identification and service connection by JJ and enable timely initiation and engagement in evidence-based SUD treatment provided by CMHCs. We have employed a LHS alliance model to develop alliances between JJ and CMHCs. We have maximized opioid use prevention efforts by implementing a bundled treatment approach to improve screening, resource allocation, workforce development and evidence-based interventions (EBIs) that target a range of SUD risk levels. We hypothesize that ADAPT – a combination of the LHS alliances and dissemination of targeted SUD EBIs – will positively affect SUD and recidivism outcomes over time. We will begin our evaluation of this intervention. Thus, the goal of this supplement is to gather cost data on the LHS and EBI expansion. We will be evaluating the benefit of ADAPT by completing the main aims of this project. By gathering cost data, we will also be able to evaluate the cost effectiveness of this model and evaluate the implementation costs. We will utilize our expertise in implementation science, community-based research, clinical trials, cost-effectiveness research, and linking administrative databases, for research to assess the impact of these interventions on criminal recidivism and substance use outcomes, including transition to opiate use disorders and opiate overdose. By incorporating cost effectiveness and implementation models into this work, we will be well poised to sustain this intervention and expand it to additional jurisdictions.

Through this project, we seek to improve collaboration between juvenile justice settings and community mental health centers. We will test the impact of a Learning Health System Alliance focused on continuous quality improvement and training in evidence‐based intervention. This supplement is focused on gathering relevant cost effectiveness and implementation data to evaluating the benefit of this work based on costs.