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Current Research Projects (by Expiration Date in Descending Order)

Title Justice Community Opioid Innovation Network (JCOIN) Coordinating Center and Surveys
Principal Investigator Michael L. Dennis, Ph.D.Christy K. Scott, Ph.D.
Funded By National Institute on Drug Abuse (NIDA)
Grant Number U01 DA036221
Project Period July 1, 2018 – June 30, 2020
Abstract Chestnut’s Coordinating Center (CC) provides electronic infrastructure and other support services to NIDA-funded justice grantees and FY18 Helping to End Addiction Long-term (HEAL) grant supplements, including data management and analytic support, logistical support, and dissemination. Additionally, the CC will conduct two national surveys to inform the field about the interface between criminal justice and the opioid crisis through the administration of two surveys targeting different intercept points in the CJ system. Survey #1 will include all 50 states and inform the field about the policies and procedures behind the walls in state prisons that either facilitate or prohibit the availability and access to treatment, medication-assisted treatment (MAT), and overdose education and prevention. Survey #2 will include community supervision and jails in a nationally representative sample of counties across the U.S. and will focus on the ways in which community supervision and jails either facilitate or obstruct/prohibit the availability and access to treatment, MAT, and overdose education and prevention. 

Title Juvenile Drug Treatment Court (JDTC) Multiple Site Evaluation
Principal Investigator Michael L. Dennis, Ph.D.
Contracted From American Institutes for Research (AIR)
Funded By Office of Juvenile Justice and Delinquency Prevention (OJJDP)
Grant Number 2014–DC–BX–K001
Project Period November 15, 2017 - October 31, 2020
Abstract This is a multisite evaluation of efforts to implement the Office of Juvenile Justice and Delinquency Prevention (OJJDP, 2016) Juvenile Drug Treatment Court (JDTC) Guidelines.  Directed by Chestnut Health Systems, it is being conducted in collaboration with Temple University, Northwest Professional Consortium, Inc. (dba NPC Research), and Carnevale and Associates, LLC (CALLC).This work is also a part of a larger cooperative agreement that requires working closely with AIR (prime) and its other subcontractors who have developed and will refine the guidelines based on findings from this effort, as well as OJJDP and its contractors/grantees providing training and technical assistance (TTA) to implement the guidelines and grantees from 15 jurisdictions, and who will implement the new guidelines and collect the data on their JDTC(s) and a comparison standard juvenile court. Over 2 years, each grantee jurisdiction/site will a) to recruit at least 150 youth who are “eligible” for JDTC or Traditional Juvenile Courts (TJC), b) either randomly or quasi-experimentally assign these youth to the JDTC or TJC, and c) collect data from court staff, youth records and youth interview. The primary research question for this study is: Do youth with substance use disorders experience more positive outcomes if assigned to a JDTC rather than to a traditional (i.e., non-JDTC) juvenile court program?  The outcomes to be evaluated include changes in a) recidivism, b) substance use and symptomatology, c) academic performance (grades, attendance/truancy), d) mental symptomatology and well-being, and e) relationship with parents/guardians and peers. The study will also look at several secondary research questions, including 1) Are different interpretations of the guidelines by the courts associated with better outcomes? 2) Are there certain guidelines that, if present, are associated with better outcomes? 3) Are there guidelines that, if absent, do not seem to be associated with worse outcomes (i.e., they are not necessary)?

Title Recovery Initiation and Management after Overdose (RIMO) Experiment
Principal Investigator Christy K. Scott, Ph.D.
Funded By National Institute on Drug Abuse (NIDA)
Grant Number R21/R33 DA045774
Project Period September 1, 2017 - August 31, 2021
Abstract Emergency responders, including paramedics, fire fighters, and police, routinely come into contact with individuals who have overdosed and play a critical role in administering naloxone to reverse opioid-related overdose. However, mechanisms to link these individuals to medication-assisted treatment (MAT) following an overdose are lacking. This study targets individuals in Chicago who have received naloxone administered by first responders within the past week to reverse an overdose, but who have not entered into MAT. Study participants will be recruited through partnerships with the Chicago Fire Department (CFD) and Police Department (CPD); first responders will be trained to seek consent from individuals who are alert and oriented after receiving naloxone for future contacts by research staff as part of the naloxone standard protocol. Those who consent will be contacted and screened for study eligibility within one week of naloxone administration; eligible participants will be randomly assigned either to the control group, i.e., referral to MAT as usual, or to Recovery Initiation and Management after Overdose (RIMO), an assertive linkage and recovery support intervention. This intervention builds on an evidenced-based intervention for treatment linkage, monitoring, and recovery support evaluated in 3 prior clinical trials by the study team. The Phase 1 (R21) Pilot Aim is to: Adapt and pilot test an assertive intervention (RIMO) to link individuals with opioid use disorders (OUD) whose overdose has been reversed by naloxone administered by first responders to MAT. Forty individuals will be recruited from two communities in Chicago with high rates of opioid-related overdose and naloxone administrations and will be randomly assigned to receive either the “referral only” control or “RIMO”. Assessments will be completed at baseline and outcomes collected from treatment records. Recruitment referral methods and RIMO will be refined based on pilot study findings, focus groups with RIMO participants, and input from study partners and advisory board, and the existing intervention procedures manual will be adapted. The Phase 2 (R33) Experiment will use the study recruitment and RIMO procedures refined in Phase 1 to recruit a total of 400 individuals and randomly assign them either to the referral only control or RIMO. All participants will receive standardized assessments at baseline and 1, 3, 6, 9, and 12 months post-randomization. Phase 2 Study Aims are to evaluate RIMO’s 1) direct effect on linkage to MAT, length of time on medication, dropout, and total days of MAT; and 2) direct and indirect (via MAT) effects on time to relapse, opioid use, and opioid-related overdose.

Title Smartphone Addiction Recovery Coach for Young Adults (SARC-A) Experiment
Principal Investigator Michael L. Dennis, Ph.D.
Funded By National Institute on Drug Abuse (NIDA)
Grant Number R01 DA011323
Project Period August 15, 2017 - May 31, 2022
Abstract Young adults (ages 18-26) who receive treatment for substance use disorders (SUD) have high rates of resuming substance use after they leave treatment. Although relapse prevention is widely incorporated within SUD treatment, tools for sustaining recovery are frequently lacking or inadequate. Smartphones have the potential to address this need by delivering Ecological Momentary Assessments (EMA); EMA is a self-monitoring intervention that can be used to help people identify and better understand the antecedents, patterns, and consequences of substance use. In addition, smartphones can provide immediate access to a range of recovery supports delivered via Ecological Momentary Interventions (EMI). As part of the P.I.’s MERIT award (R37 DA011323-14), the research team developed the Smartphone Addiction Recovery Coach for Young Adults (SARC-YA) mobile application, which is based on a dynamic model of relapse prevention and utilizes smartphones to deliver recovery-oriented interventions. The applicant team completed two pilot studies in which EMAs and EMIs were delivered to adolescents via smartphones, both separately and combined. Results indicated that EMAs were reliably completed (5 to 6 per day) and accurately predicted the risk of use in the next 7 days. In addition, participants completed an average of 20 or more EMIs per day and EMI utilization was associated with reduced substance use in the next 7 days. Building on these findings, the applicants propose the following experimental study. Young adults (N=400) will be recruited upon their engagement in outpatient treatment programs and randomly assigned to 1 of 2 conditions: (1) recovery support as usual control or (2) an EMA+EMI experimental condition. The experiment intervention will be delivered via SARC-YA for 6 months post-randomization with quarterly assessments through 9 months. Data include standardized assessments, urine tests, mobile phone meta data, EMA responses, and EMI utilization. Study hypotheses will be tested using survival analysis, multi-level modeling and structural equation modeling of longitudinal data. The study has the following aims:  Aim 1: Test the effects of EMA+EMI (v control) on the frequency of substance use; Aim 2: Evaluate the extent to which the above effects are moderated by baseline substance use frequency; Aim 3: Test the extent to which the frequency of substance use mediates the effects of EMA+EMI on other aspects of recovery including SUD symptoms, HIV risk behavior, quality of life, mental wellness, days of school; and Aim 4: Determine the degree to which EMA responses and EMI utilization predict the duration of abstinence.

Title Recovery Management Checkups for Primary Care (RMC-PC) Experiment
Principal Investigator Christy K. Scott, Ph.D.
Funded By National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Grant Number R01 AA24440
Project Period January 27, 2017 – December 31, 2022
Abstract Screening and Brief Intervention (SBI) in primary care for risky adult alcohol use has been demonstrated effective in reducing use among heavy alcohol users. While the process also identifies 5-10% of the patients who have substance use disorders (SUD) that require referral to alcohol and other drug (AOD) treatment, the most recent meta-analysis indicates that the procedures had little to no effect on actual treatment linkage and utilization. Patient and system level barriers present challenges and new linkage models are needed that can successfully overcome the barriers. Results from three clinical trials conducted by the applicant team have demonstrated the effectiveness of Recovery Management Checkups (RMC) as a linkage model for individuals needing AOD treatment. Moreover, RMC participants were significantly more likely to enter treatment, enter sooner, and stay longer, having fewer days of use and fewer SUD symptoms. Outcomes were also associated with lower health care utilization, decreased criminal activity, and substantial savings to society, thereby offsetting the costs of additional treatment. RMC was modified for primary care (RMC-PC) and pilot results indicated RMC-PC significantly increased linkage rates to treatment relative to a baseline cohort (12% vs. 75%, OR=22.0, p<.0001). In the proposed trial, we will: a) recruit 300 adult patients with SUD through SBIRT programs operating in five sites operated by three FQHC organizations, b) randomly assign half to a referral as usual control and half to RMC-PC, and c) conduct quarterly follow-ups for 12-months post enrollment. Hypotheses include: H1 Relative to the control patients, RMC-PC patients will be more likely to initiate AOD treatment sooner, receive any AOD treatment, and receive more days of AOD treatment; H2 Relative to the control patients, RMC-PC patients and those who receive more AOD treatment will report fewer days of heavy alcohol use, other drug use, any AOD use and SUD problems; H3 The days of treatment will mediate the relationship between RMC-PC and changes in the pre and post measures of these AOD related behaviors; H4 Relative to the control patients, RMC-PC patients and those with fewer days of AOD use will have significantly less total health care utilization costs after factoring in increases in AOD treatment; and H5 The days of AOD use will mediate the relationship between RMC-PC and the cost of health care utilization.

Title State Opioid Response (SOR)/Tribal Opioid Response (TOR) Grant
Principal Investigator Christy K. Scott, Ph.D.
Contracted From Illinois Department of Human Services (IDHS)
Funded By Center for Substance Abuse Treatment (CSAT)
Grant Number TI081699-01
Project Period December 1, 2018 - November 30, 2021
Abstract Based on an analysis of Illinois’ Division Automated Reporting and Tracking System (DARTS) data for State Fiscal Year 2016, there were 49,887 total admissions to the Illinois Department of Human Services (IDHS)/Division of Substance Use Prevention and Recovery (SUPR) funded treatment services. A total of 14,885 (29.8%) of these admissions were persons who indicated opioids as their primary substance of abuse, with heroin accounting for 83.8% of these primary opioid admissions. Based on the information available, only 9.1% (1,349) of these primary opioid patients were admitted to IDHS/SUPR-supported MAT services. IDHS/SUPR is proposed a comprehensive continuum of OUD outreach, medication-assisted treatment (MAT), recovery support, and prevention services in response to the critical nature of the opioid crisis in Illinois. Agencies will provide services to participants including peer outreach, linkage to treatment, and medication-assisted treatment (MAT), such as Outpatient Methadone Treatment (OMT), Vivitrol Injection Services, Buprenorphine, and Community Reinforcement Approach (CRA). Approximately 4500 people are expected to receive SOR related services over 2 years.

Title Treating Rural Adult Clients with Technology (TRACT)
Principal Investigator Lora L. Passetti, M.S. 
Funded By Center for Substance Abuse Treatment (CSAT)
Grant Number 1H79TI026425-01
Project Period September 30, 2016 - September 29, 2019
Abstract Research shows that rural residents with substance use disorders have more barriers to accessing outpatient and continuing care treatment than those who live in urban areas. Chestnut Health Systems proposes to enhance its capacity to provide evidence-based substance use treatment for rural adults through the use of a combination of tele-health and web-based treatment services to deliver the Community Reinforcement Approach. The population of focus for the proposed “Technology-Based Treatment” project is rural adults who reside in underserved areas within 11 counties located in central Illinois who are: 1) admitted to outpatient treatment for substance use disorders; OR 2) discharged from residential treatment for substance use disorders and admitted to continuing care. Based on existing data, we anticipate that rural participants in this project will have the following characteristics: 45% female, 3% African American, 4% Hispanic, and 3% Other. Average age will be 32 years old. Sixty-five percent will be involved with the criminal justice system, 31% employed, 51% using alcohol weekly, 31% using marijuana weekly, 25% using cocaine weekly, 11% using heroin weekly, 70% presenting with symptoms of Major Depressive Disorder, and 50% presenting with symptoms of generalized anxiety disorder. The four primary goals of this project are to: 1) share effective treatment models and results among providers; 2) increase engagement of persons in treatment in their health care; 3) increase monitoring and tracking of the health status of individuals; and 4) improve recovery and resiliency rates. These goals will be achieved by implementing the project’s measurable objectives as defined by the Washington Circle Group: increase continuity of care after assessment; increase continuity of care after residential discharge; increase treatment initiation; and increase treatment engagement. We plan to serve 76 unduplicated individuals in year 1, 98 unduplicated individuals in year 2, and 87 unduplicated individuals in year 3. Thus, over the course of the three-year project, we plan to serve a total of 261 unduplicated adults living in rural areas of central Illinois. In addition to improving the availability, accessibility, and acceptability of and rates of retention in treatment for rural populations with substance use disorders in central Illinois, this project is significant in that it seeks to substantially improve compliance with national Washington Circle performance standards, as well as improve dissemination of technology-based treatment to other rural areas of the United States.

Title State Targeted Response (STR) to the Opioid Crisis
Principal Investigator Christy K. Scott, Ph.D.
Contracted From Illinois Department of Human Services (IDHS)
Funded By Center for Substance Abuse Treatment (CSAT)
Grant Number 1H79TI080231-01
Project Period July 1, 2017 – April 30, 2020
Abstract In 2011, the Chicago Metropolitan Area ranked first nationally for both emergency department (ED) mentions (24,627) for heroin (Drug Abuse Warning Network) and percentage (18.6%) of individuals who were arrested and tested positive for heroin (Arrestee Drug Abuse Monitoring Program). In Chicago and nationally, there is an emerging consensus on the need to address this epidemic and a particular focus on broad dissemination of over-the-counter Naloxone to prevention opioid overdose and death. Efforts are currently underway (and supported by federal and state funds) to distribute Naloxone and train individuals in its use. There is no one place to find all or even most of the people at risk of overdose. This project seeks to address this gap by combining two well established protocols: 1) Peer Outreach Workers (POW) to identify and recruit opioid users and 2) Recovery Management Checkups (RMC) to link and engage people in substance use disorder (SUD) treatment. The general efficacy of POW has been well established in over 3 dozen studies with injection drug users and crack users, but has not yet been applied to prescription opioid users. The general efficacy of RMC has been established in 3 clinical trials with opioid users (both injection and other) recruited from SUD treatment and jail, as well as 1 quasi experiment study (referral from primary care).  

Title Using Smartphones to Provide Recovery Support Services
Principal Investigator Christy K. Scott, Ph.D.
Funded By National Institute on Drug Abuse (NIDA)
Grant Number R01 DA035879
Project Period May 1, 2014 - February 28, 2020
Abstract The primary goal of the proposed trial is to examine the effect of combining more frequent self-monitoring via EMAs and automated interventions via Ecological Momentary Interventions (EMIs) provided by A-CHESS, on days of abstinence from drugs and alcohol and HIV risk behaviors over 6 months following treatment discharge. We will recruit 400 participants at discharge (both planned or unplanned) from Illinois’ largest treatment organization and randomly assign them in a 2 x 2 factorial design to receive EMA only, EMI only, combined EMA+EMI, or neither (control). Participants in the 3 EMA and EMI groups will receive a smartphone and training after discharge. To help them self-monitor, individuals in the EMA groups will be randomly signaled 6 times daily for 6 months and asked to record their recent substance use, HIV risk behaviors (e.g., needle use, unprotected sex) and exposure to internal and external protective and risk factors, then to rate the extent to which these factors support their recovery or make them want to use drugs or alcohol. Individuals in the EMI groups will have 24/7 access to A-CHESS. In the combined EMA+EMI group, participants will receive feedback directly following completion of each 2-3 minute EMA, and EMA responses will be used to encourage EMI utilization. The AIMS of this experiment are to: Aim 1. Test the effect of EMA, EMI and EMA+EMI on days of abstinence; Aim 2. Test the effect of EMA, EMI and EMA+EMI on HIV risk behaviors; and Aim 3. Evaluate the extent to which changes in days of abstinence mediate the effect of EMA, EMI, and EMA+EMI on HIV risk behaviors.
Title Juvenile Justice - Translational Research on Interventions for Adolescents in the Legal Systems (JJ-TRIALS) Coordinating Center to Reduce Substance use, HIV Risk Behaviors, & Crime
Principal Investigator Michael L. Dennis, Ph.D., Christy K. Scott, Ph.D.
Funded By National Institute on Drug Abuse (NIDA)
Grant Number U01 DA036221
Project Period July 1, 2013 - June 30, 2021
Abstract Through the Coordinating Center (CC) and six Research Centers (RCs), the cooperative will seek to improve the continuum of evidence-based services available to youth within the juvenile justice system. The Coordinating Center’s aims are to 1) conduct a national survey of juvenile justice agencies that provides a context and comparison standard for the TRIALS pre-implementation needs assessment and subsequent implementation studies; 2) coordinate each Research Center’s pre-implementation needs assessment; 3) develop and manage a common data base infrastructure for cross-site research implementation studies, and 4) provide communications and logistical support. To examine the needs and services provided to youth on community supervision, the CC was responsible for conducting a national survey of juvenile justice agencies, behavioral health agencies, and judges. The survey was conducted with a sample of 20 states and 192 counties, which were randomly selected based on the size of their adolescent population. The survey objectives were to a) Identify screening and assessment tools and procedures currently being used; b) Identify what services are available and to whom; c) Identify evidence-based practices being used; d) Determine the extent to which services are integrated; e) Determine the extent to which youth and families utilize the different types of services; f) Assess the availability and efficacy of linkage/referral services; g) Inquire about the presence of administrative data systems to monitor service implementation and outcomes. The CC will conduct the survey again in 2017 using the same sample of states and counties to measure outcomes.
Title Evidence-Based Treatment (EBTx) Center
Director Mark D. Godley, Ph.D.
Funded By Federal and state agencies and local provider organizations throughout the U.S. and Canada
Project Period Variable (12-48 months)
Abstract The primary goal of Chestnut’s Evidence-Based Treatment (EBTx) Center is to improve the quality and outcomes of treatment for substance use disorders by disseminating evidence-based treatments to provider organizations. Dissemination strategies are based on recommendations from implementation science research and involve training, competency-based learning (for practice and feedback), coaching, and on-demand technical support.  Another goal of the EBTx Center is to help each provider organization develop the capacity to self-sustain evidence-based treatment. To date, the EBTx Center has worked with more than 270 provider organizations resulting in over 1,000 EBT-certified clinical supervisors and clinicians. As a result, in excess of 12,000 patients and their families have received one of the following evidence-based treatments: 1) the Adolescent Community Reinforcement Approach (A-CRA); 2) Assertive Continuing Care (ACC); 3) the Community Reinforcement Approach (CRA) for adults; and 4) Recovery Management Support (RMS).
Title GAIN Coordinating Center (GCC)
Director Michael L. Dennis, Ph.D.
Funded By Federal and state agencies and local provider organizations throughout the U.S. and Canada
Project Period Variable (dependent upon services requested)
Abstract The primary goal of Chestnut’s GAIN Coordinating Center (GCC) is to bridge the gap between clinical research and the growing movement toward evidence-based practice. Dissemination strategies are based on recommendations from implementation science research and involve training, competency-based learning (for practice and feedback), coaching, technical support, data services, and clinical support. A key goal of the GCC is to help each organization develop the capacity to self-sustain evidence-based assessment utilizing a “train the trainer” model. The Global Appraisal of Individual Needs (GAIN) is a family of instruments which originated in 1993 as a collaborative effort between clinicians, researchers, and policy makers to create comprehensive and standardized screening and bio-psychosocial assessment tools. All of the GAIN instruments are available via web-based interactive administration hosted on a secured network to insure maximum protection of confidential information. The GCC has over 5,155 licensed GAIN entities in all 50 U.S. states and all 10 provinces of Canada, as well as 10 other countries (Australia, Belgium, Brazil, China, Mexico, Japan, Great Britain, India, South Africa, Spain). As of 12/31/18, the current ABS software system has been used by 1,349 agencies to help 15,590 staff administer 893,846 interviews. In collaboration with these programs and staff, norms, psychometrics, and 538 publications have been publicly provided on over 100,000 adolescents, young adults and adults. In 2019, the GCC is developing two new and larger data sets: The first is for the Bureau of Indian Affairs to look at the treatment needs of Native Americans; the second is for the National Institute on Drug Abuse (NIDA) to look at how treatment needs have changed due to the opioid epidemic and growing re-emergence of methamphetamines.