Jenna van Draanen

Introduction: Research with Expert Advisors on Drug Use (READU) is a community-engaged research collaborative of people with lived and living experience, clinicians, and academic researchers. We sought to evaluate the challenges and rewards of the partnership model. Materials and methods: Using the Peer Engagement Process Evaluation framework, the READU team collaborated on generating a list of focus group topics. All ( n = 8) active team members participated in a focus group. Thematic analysis was used to identify key ideas. Results: Five main themes were identified. “Collaborative Research Model” relates to the importance of a shared set of values, power dynamics, and the importance of centering community in research. “Group Dynamics” describes occasionally getting side-tracked in the work, as well as closeness among team members. “Individual Growth and Skill Development” concerns personal and intellectual development, as well as the benefits and opportunities for bi-directional training. “Institutional Structure,” encompasses the logistics of a hybrid working model and compensation issues. “Moving Forward and Future Work” involves the process of ending a research project in a positive way and envisioning future opportunities. Discussion: READU’s partnership model is generally positive and mutually beneficial for all team members. All partners feel a sense of satisfaction and closeness, and that the relevance and impact of research is enhanced. Although some challenges have been identified, particularly related to compensation and the physical workplace, these are not intractable. The evaluation of this partnership should motivate researchers considering partnership with peer researchers and highlight practical considerations.

Background: Structural racism continues to drive racial disparities in opioid-related deaths by creating inequitable access to healthcare, shaping prescription practices, limiting availability of culturally responsive care, and concentrating socioeconomic disadvantage in racial/ethnic minority communities. Emergency Medical Services (EMS) based interventions provide a critical opportunity to address these disparities at the frontlines of care, as minoritized communities often utilize EMS as their usual source of care. In King County, Washington, EMS has begun implementing several system changes aimed at reducing opioid overdose deaths, promoting harm reduction strategies, increasing access to overdose prevention resources, and improving outcomes for individuals who survive overdoses. The Overdose Response Centering Inequity and Diversity (ORCID) study will evaluate these EMS system changes to understand their impact on opioid-related outcomes differentially by race and ethnicity.Methods: This study employs a mixed-methods, hybrid effectiveness-implementation design with three aims: (1) to understand experiences and outcomes for minoritized racial groups at the patient level using a prospective cohort study (n = 500) of non-fatal overdose survivors; (2) to evaluate EMS system changes’ implementation processes from the perspectives of Black, Hispanic/Latinx, and American Indian/Alaska Native non-fatal overdose survivors using in-depth interviews (n = 60); and (3) to examine population-level impacts of EMS system changes on racial disparities using secondary data from King County EMS. Utilizing an innovative community-based participatory approach, this study centers and incorporates individuals with lived and living experience of drug use as equal partners throughout the research process.Discussion: Through a rigorous evaluation of EMS system changes in King County, this study will generate actionable insights for improving EMS responses to the opioid epidemic and addressing racial disparities both locally and nationally. As one of the first studies to track a longitudinal cohort of non-fatal overdose survivors, ORCID will provide critical data on both short- and long-term outcomes, informing future interventions focused on improving continuum of care for overdose survivors. By employing a community-engaged approach, the study centers the lived experiences of those most affected and enhances the relevance of the study findings. Potential limitations include the rapidly evolving landscape of EMS interventions and biases associated with non-random sampling.

Background: School based health centers (SBHCs) are essential for providing health care to students. Literature demonstrates student characteristics such as race and income are associated with SBHC utilization; however, little data exists on temporal trends in utilization. This gap in knowledge is crucial for informing policies and resource allocation.Methods: This study examined utilization across 27 SBHCs at elementary, middle, and high schools in King County, Seattle from 2017 to 2021. Negative binomial models with random intercepts were constructed to evaluate semester‐level variation in utilization, accounting for school‐level differences in race, income, and attendance. Interaction models were constructed to test for effect modification of utilization by race, income, and attendance.Results: Findings indicate that higher rates of utilization occurred in the fall. There was a decrease in utilization during the study, potentially due to the pandemic. Lower school‐level income was positively and significantly associated with higher utilization and none of the interaction models were significant.Implications: Our study holds important implications for planning and policy recommendations surrounding SBHC care delivery, such as the potential need for more staffing to meet the higher demand in the fall.Conclusion: SBHC utilization varies by semester and schools serving low‐income communities may experience higher rates of utilization, requiring increased staffing needs.

Introduction: The implementation of supervised smoking facilities (SSFs) as a harm reduction intervention has public health benefits for people who inhale drugs, but there are significant knowledge gaps surrounding the perspectives of SSF visitors and staff on their implementation and accessibility. We conducted this study to learn about their perspectives on barriers and facilitators to accessibility at SSFs. Methods: The study used a community-based participatory research study design. PWUD and SSF leadership were involved in all phases of the research project as members of the research team. Between June 2021 and April 2022, we conducted 10 qualitative semi-structured interviews with peer workers and stakeholders at an SSF in Vancouver, Canada to examine perspectives on how to facilitate accessibility for visitors. Interviews were analyzed using an abductive analytic approach, themes were defined and organized collaboratively by the research team. Results: Peer workers and SSF leadership interviewed in the study described aspects of the SSF that contributed to a low-barrier service model and resulted in greater accessibility for visitors, including: (1) non-punitive approaches to interpersonal challenges, (2) anonymity and privacy, (3) peer involvement, and (4) physical environment. Limitations to access were also described and included: (1) age restrictions, (2) geographical location and (3) infrequent, temporary bars for certain behaviors. Discussion: Findings from this study identified many dimensions of the low-barrier SSF service model and site design that may contribute to greater accessibility for SSF visitors. Findings from this study could be used to inform the scale-up and implementation of SSFs as a harm reduction approach to reducing mortality and other negative outcomes related to the current drug toxicity crisis.

Background: The increasing implementation of harm reduction strategies such as take-home naloxone has placed people who use drugs (PWUD) in the position of overdose responders during overdose events, but the perspectives of PWUD are underrepresented in public health policy and practice concerning overdose response. We conducted this study to examine PWUD’s perspectives on first response services for overdose and to learn how PWUD can be supported more effectively when they respond to overdoses. Methods: The Research with Expert Advisors on Drug Use (READU) team, a community-based research team that includes academically trained researchers and people with lived and living experience conducted 13 semistructured interviews with PWUD in King County. The data were analyzed via thematic analysis. The Consolidated Framework for Implementation Research (CFIR) was used to guide the development of the interview protocol and as a framework for qualitative codebook development. Results: Participants were asked to describe their experiences with EMS, including police, during overdose response. Most had reversed an overdose themselves and demonstrated commitment to their role as overdose responders. Participants had mixed feelings about EMS involvement in overdose response, citing concerns about stigma and coercion. Police response was described as negatively impacting peer overdose response, with participants stating that past experiences of arrest and harassment by police during overdose response contributed to their reluctance to call 911 during an overdose. Conclusion: The findings from this study demonstrate the important role of PWUD in overdose response and suggest that improving interactions between EMS and PWUD could positively impact future responses, including increasing PWUD’s willingness to call 911 during overdose events.

Background: Although substantial progress has been made in establishing evidence-based psychosocial clinical interventions and implementation strategies for mental health, translating research into practice—particularly in more accessible, community settings—has been slow. Objective: This protocol outlines the renewal of the National Institute of Mental Health–funded University of Washington Advanced Laboratories for Accelerating the Reach and Impact of Treatments for Youth and Adults with Mental Illness Center, which draws from human-centered design (HCD) and implementation science to improve clinical interventions and implementation strategies. The Center’s second round of funding (2023-2028) focuses on using the Discover, Design and Build, and Test (DDBT) framework to address 3 priority clinical intervention and implementation strategy mechanisms (ie, usability, engagement, and appropriateness), which we identified as challenges to implementation and scalability during the first iteration of the center. Local redesign teams work collaboratively and share decision-making to carry out DDBT. Methods: All 4 core studies received institutional review board approval by June 2024, and each pilot project will pursue institutional review board approval when awarded. We will provide research infrastructure to 1 large effectiveness study and 3 exploratory pilot studies as part of the center grant. At least 4 additional small pilot studies will be solicited and funded by the center. All studies will explore the use of DDBT for clinical interventions and implementation strategies to identify modification targets to improve usability, engagement, and appropriateness in accessible nonspecialty settings (Discover phase); develop redesign solutions with local teams to address modification targets (Design and Build phase); and determine if redesign improves usability, engagement, and appropriateness (Test phase), as well as implementation outcomes. Center staff will collaborate with local redesign teams to develop and test clinical interventions and implementation strategies for community settings. We will collaborate with teams to use methods and centerwide measures that facilitate cross-project analysis of the effects of DDBT-driven redesign on outcomes of interest. Results: As of January 2025, three of the 4 core studies are underway. We will generate additional evidence on the robustness of DDBT and whether combining HCD and implementation science is an asset for improving clinical interventions and implementation strategies. Conclusions: During the first round of the center, we established that DDBT is a useful approach to systematically identify and address chronic challenges of implementing clinical interventions and implementation strategies. In this subsequent grant, we expect to increase evidence of DDBT’s impact on clinical interventions and implementation strategies by expanding a list of common challenges that could benefit from modification, a list of exemplary solutions to address these challenges, and guidance on using the DDBT framework. These resources will contribute to broader discourse on how to enhance implementation of clinical interventions and implementation strategies that integrate HCD and implementation science. International Registered Report Identifier (IRRID): PRR1-10.2196/65446

Introduction: Emergency medical services (EMS) systems are piloting interventions to respond to overdoses with additional services such as leave‐behind naloxone and medication for opioid use disorder, but little is known about the perspectives of people who use drugs (PWUD) on these interventions being delivered by EMS during an overdose response.Methods: The Consolidated Framework for Implementation Research guided the development of data collection tools, the analytic strategy and the organisation of results. A community engaged method was used which included both academically trained researchers and community trained researchers who are also PWUD. This study used semi‐structured interviews to gather data from 13 PWUD in King County, Washington in June 2022. Data were analysed using thematic analysis.Results: The people interviewed for this study viewed EMS distribution of leave‐behind naloxone and field‐based buprenorphine favourably. They viewed EMS facilitation of hepatitis C virus and HIV testing in the field less favourably and were concerned about stigmas associated with those results. Additional themes emerged regarding: the need for different approaches to post‐overdose care; the need for new services, including post‐overdose trauma counselling and an alternative destination to the emergency department; and the harms of law enforcement presence at overdose responses.Discussion and Conclusions: This study found strong support for leave‐behind naloxone and field‐initiated buprenorphine. Further training for EMS should include trauma‐informed care and strategies to address burnout and increase compassion. Alternatives to the emergency department as a post‐overdose destination are needed. These strategies should be considered by jurisdictions revising overdose response protocols.

Introduction: Recent policy changes in Washington State presented a unique opportunity to pair evidence-based interventions with first responder services to combat increasing opioid overdoses. However, little is known about how these interventions should be implemented. In partnership with the Research with Expert Advisors on Drug Use team, a group of academically trained and community-trained researchers with lived and living experience of substance use, we examined facilitators and barriers to adopting leave-behind naloxone, field-based buprenorphine initiation, and HIV and hepatitis C virus (HCV) testing for first responder programs. Methods: Our team completed semi-structured, qualitative interviews with 32 first responders, mobile integrated health staff, and emergency medical services (EMS) leaders in King County, Washington, from February–May 2022. Semi-structured interviews were recorded, transcribed, and coded using an integrated deductive and inductive thematic analysis approach grounded in community-engaged research principles. We collected data until saturation was achieved. Data collection and analysis were informed by the Consolidated Framework for Implementation Research. Two investigators coded independently until 100% consensus was reached. Results: Our thematic analysis revealed several perceived facilitators (ie, tension for change, relative advantage, and compatibility) and barriers (ie, limited adaptability, lack of evidence strength and quality, and prohibitive cost) to the adoption of these evidence-based clinical interventions for first responder systems. There was widespread support for the distribution of leave-behind naloxone, although funding was identified as a barrier. Many believed field-based initiation of buprenorphine treatment could provide a more effective response to overdose management, but there were significant concerns that this intervention could run counter to the rapid care model. Lastly, participants worried that HIV and HCV testing was inappropriate for first responders to conduct but recommended that this service be provided by mobile integrated health staff. Conclusion: These results have informed local EMS strategic planning, which will inform roll out of process improvements in King County, Washington. Future work should evaluate the impact of these interventions on the health of overdose survivors.