Improving youth OUD treatment through family engagement and assertive outreach

Young people are disproportionately affected by the current opioid crisis in the US, with catastrophic consequences for youth and their families. But youth are typically poor utilizers of services, and have been shown to have worse retention and outcomes for OUD than older adults. Fewer adolescents and young adults with OUD receive any relapse prevention medication. Despite the clear and urgent need, there is still a lack of research and clinical consensus on youth-specific treatment models. In particular, while we have evidence for effectiveness of medications, we have little evidence for the most effective delivery models for these medications. Many practitioners have questions, and struggle with this "mysterious" and difficult to engage population. We have a long way to go in optimizing engagement and retention.

The Youth Opioid Recovery Support (YORS) model is an innovative wrap-around approach that incorporates home delivery of extended release naltrexone, family engagement, and assertive outreach. By literally meeting youth and families where they are, home delivery of medication aims to engage and retain youth that have not or would not be likely to succeed in more traditional models. The impact of family engagement has been poorly applied in treatment of young adults because of inadequate training, over-rigid concerns about confidentiality, and the developmentally normative push-back by young adults against their subjective sense of family “intrusiveness.” But respecting the rights of youth and empowering families are compatible. Family engagement includes: participation in treatment planning sessions, development of a written family treatment agreement, development of a “back-up plan” in the event of relapse, and promotion of medication adherence. Assertive outreach consists of staff taking the active lead in treatment engagement, using whatever mode of communication works (phone, text, email, facebook , etc).

Our pilot case series (Vo, 2017) showed benefit of the YORS model compared to a historical TAU cohort. A small randomized controlled trial nearing completion shows promising results. Out of a total N = 45, 31 subjects have completed 3-month follow up, and 22 have completed 6 months. YORS participants received mean 2.1 outpatient doses at 3 months, and 4.5 outpatient doses at 6 months, compared to 0.3 and 0.8 doses for Treatment as Usual (TAU), respectively. 56% of YORS participants received all recommended/prescribed doses at 3 months and 45% at 6 months, compared to 0% and 0% for TAU, respectively. Finally, 68% of YORS had not met relapse criteria at 3 months and 56% at 6 months, compared to 15% and 9% for TAU, respectively.

This workshop will feature an introductory didactic session featuring brief material on the scope of the problem, the treatment setting, a description of the interventions, and a summary of the outcome data to date. The second (and largest) section of the workshop will feature an interactive, case-based format. Workshop leaders will present 4-5 cases with background and treatment course, each punctuated by "what would you do next." management questions for guided discussion at several pivotal decision points in the course. Cases are chosen to reflect real world concerns and clinical conundrums, key learning objectives, practice debates and controversies. The goal is to engage participants in a lively conversation about developmentally-informed strategies, approaches, and treatment options in the treatment of this critical target population.