A Digital Toolkit to Address Intimate Partner Violence in Opioid Use Disorder

PROJECT SUMMARY/ABSTRACT Intimate partner violence (IPV), posttraumatic stress disorder (PTSD), and opioid use disorder (OUD) are highly co-occurring conditions. Up to 94% of individuals using opioids report current or past IPV, and 64% of individuals with IPV meet diagnostic criteria for PTSD. There are increasing calls for all people to be screened for IPV across healthcare settings. However, to date, there are no well-established evidence-based screening, assessment, and referral programs for IPV or its consequences, such as PTSD, in opioid treatment programs (OTPs). Validated assessments and evidenced-based care programs—such as violence shelters and PTSD treatments—exist; however, current data show valid assessment tools may not be routinely implemented in OTP settings and that treatment providers in these settings may not feel confident in their ability to assess and refer for IPV and related issues. The proposed study directly addresses this major clinical gap by testing whether the development and implementation of a digital, decision-support toolkit for IPV and co-occurring mental health conditions will increase standard screening for IPV, uptake of referrals, improve clinic workflows, and enhance clinical outcomes. The proposed study includes three separate aims, two in the R61 phase and a stepped-wedge randomized trial in the R33 phase. In Aim 1 (R61), informed by the Consolidated Framework for Implementation Research, we will conduct stakeholder interviews with providers, IPV advocacy specialists, and IPV survivors to inform the development of the digital toolkit to assess for IPV, PTSD, and associated conditions in OTPs. An iterative process of design for the digital toolkit will be employed. The decision-support algorithms will be developed to enhance automation of referrals following assessments. In Aim 2 (R61), we will beta test the digital toolkit with 12 provider-patient dyads in each participating OTP and further refine the digital toolkit. Go/No-Go criteria for the R33 phase will include quantitative and qualitative thresholds of acceptability, feasibility, appropriateness, and usability of the toolkit based on data provided from beta testers. If criteria are met, in Aim 3 (R33), we will apply the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to evaluate the digital toolkit in a randomized stepped-wedge, hybrid implementation-effectiveness type II design among N=780 individuals with OUD seeking care at one of the three OTPs in South Carolina. Drs. Jarnecke and Saraiya (MPIs) have assembled a team of renowned investigators with expertise in OUD, IPV, PTSD, clinical trials, digital interventions, and dissemination and implementation science. Findings could transform clinical practice by enhancing standard screening, assessment, and referral of IPV and associated conditions, and reduce IPV, PTSD, and OUD in the state of South Carolina, which has one of the highest rates of IPV in the U.S.