Pathways to Treatment: Assessing Effectiveness and Implementation of Oregon's Deflection Programs for People who Use Drugs - We propose a multisite study to assess the reach, effectiveness, and implementation of 3 different models of Oregon's new deflection programs. Deflection programs are partnerships between public safety and public health agencies to divert people with substance use disorder (SUD) away from the criminal–legal system (CLS) by linking them with treatment and other services. More than 600 deflection programs exist across the U.S., with more expected as communities consider criminal justice reform. Oregon provides an excellent state for a rigorous multisite evaluation because 28 of 36 counties are implementing 3 types of deflection programs with respect to who intercepts people who use drugs (PWUD), including officer intervention only (OI), mobile crisis/community response and officers (MCCR+OI), and District Attorneys and officers (DA+OI). We will strengthen the evidence base by conducting the first multisite evaluation of Oregon’s deflection programs and address the following aims: (1) determine how Oregon’s counties are Adopting, Implementing, and Maintaining deflection programs; (2) assess the Reach of 3 different types of deflection programs at the county level; and (3) determine the Effectiveness of 3 types of deflection programs in reducing criminal–legal system involvement and increasing substance use disorder treatment for PWUD. For Aim 1, we will conduct qualitative interviews with leaders from law enforcement, district attorney offices, and behavioral health across 12 selected counties. For Aim 2, we will use state administrative CLS and deflection data from all Oregon counties to compare enrollment by the 3 types of deflection programs (OI, MCCR+OI, DA+OI). For Aim 3, we will conduct a prospective cohort study of 900 PWUD across the same 12 Aim 1 Oregon counties. Participants surveyed at baseline will be asked to provide data waivers for our team to access their deflection program participation, CLS engagement, and SUD treatment linkage outcomes in Oregon State administrative systems for 2 years. We will use these longitudinal data to assess overall program effectiveness and determine which of the 3 intercept models reduce CLS involvement and increase treatment linkage and retention. Our team includes a sociologist (Smiley-McDonald), epidemiologist (Kral), implementation scientist (Lambdin), criminologist (Campbell), and statistician (Williams) with many decades of relevant research experience. Our justice partner is Kelly Officer (Oregon Criminal Justice Commission) and our behavioral health partner is Julia Dilley (Oregon Health Authority). Comagine Health will support data collection efforts for Aim 3. A community board with 10 Oregonians will advise the team prior to study launch, during study execution, and through the dissemination process. This study will provide a generalizable scientific evidence base to help states and counties make decisions about which deflection program models to implement and how to do so. This study is part of the NIH’s Helping to End Addiction Long-term (HEAL) initiative to speed scientific solutions for the overdose epidemic, including opioid and stimulant use disorders. The NIH HEAL Initiative bolsters research across NIH to address the national opioid public health crisis and improve treatment for opioid misuse and addiction.
