outcomes measures for sexual minority patients in an opioid treatment program
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Outcomes Measures for Sexual Outcomes Measures for Sexual Minority Patients in an Opioid Minority Patients in an Opioid
Treatment ProgramTreatment Program
C. John-Hull, S. Kritz, M. Chu, C. Madray, C. John-Hull, S. Kritz, M. Chu, C. Madray, G. Dominguez, C. Bowers, R. Sumpter, G. Dominguez, C. Bowers, R. Sumpter,
J. Mitchell, L.S. Brown J. Mitchell, L.S. Brown
Addiction Research and Treatment Corp, Brooklyn, NY Addiction Research and Treatment Corp, Brooklyn, NY 1120111201
Submitted as R-21 application in response to NIDA PA-06-Submitted as R-21 application in response to NIDA PA-06-218: 218:
Health Research with Diverse Populations Health Research with Diverse Populations
ABSTRACTABSTRACTStudies of sexual minorities have overwhelmingly been Studies of sexual minorities have overwhelmingly been cross-sectional and descriptive. Some of the findings are: cross-sectional and descriptive. Some of the findings are: (1) increased risk for mental health and substance abuse (1) increased risk for mental health and substance abuse problems; (2) different substances of abuse; (3) problems; (2) different substances of abuse; (3) engagement in riskier sexual practices; and, (4) unique engagement in riskier sexual practices; and, (4) unique healthcare access issues as compared to heterosexuals. healthcare access issues as compared to heterosexuals. The Addiction Research and Treatment Corporation is the The Addiction Research and Treatment Corporation is the largest non-hospital based Opioid Treatment Program in largest non-hospital based Opioid Treatment Program in New York State, serving more than 3,000 patients New York State, serving more than 3,000 patients annually. We provide a wide range of healthcare and annually. We provide a wide range of healthcare and social services to patients throughout Brooklyn and social services to patients throughout Brooklyn and Manhattan. On the basis of anonymous surveys, there is Manhattan. On the basis of anonymous surveys, there is clearly an interest in having programs geared towards this clearly an interest in having programs geared towards this population. In response to a NIDA R-01 Program population. In response to a NIDA R-01 Program Announcement (PA-06-218), we propose to do a pre and Announcement (PA-06-218), we propose to do a pre and post-intervention study that evaluates sexual minority post-intervention study that evaluates sexual minority patients participating in specialized groups in the patients participating in specialized groups in the following outcomes measures: (1) substance abuse; and, following outcomes measures: (1) substance abuse; and, (2) quality of life. These particular outcomes were chosen (2) quality of life. These particular outcomes were chosen because they will provide sufficient data for statistical because they will provide sufficient data for statistical analysis of significance, which is lacking in studies of this analysis of significance, which is lacking in studies of this population. population.
ACKNOWLEDGEMENTSACKNOWLEDGEMENTS PATIENTS AND PATIENTS AND
STAFF OF THE STAFF OF THE ADDICTION ADDICTION RESEARCH AND RESEARCH AND TREATMENT TREATMENT CORPORATION, A CORPORATION, A COMMUNITY-COMMUNITY-BASED BASED SUBSTANCE SUBSTANCE ABUSE SERVICE ABUSE SERVICE AGENCYAGENCY
ACKNOWLEDGEMENTSACKNOWLEDGEMENTS
•There are no financial interests or There are no financial interests or disclosures to report for any of the disclosures to report for any of the authors involved in this projectauthors involved in this project
BACKGROUNDBACKGROUND
Studies of sexual minority substance Studies of sexual minority substance abusers have been largely cross-abusers have been largely cross-sectional and descriptivesectional and descriptive
Longitudinal studies have been Longitudinal studies have been virtually non-existent virtually non-existent
ARTC provides substance abuse ARTC provides substance abuse treatment to a predominantly (90%) treatment to a predominantly (90%) racial/ethnic minority population that racial/ethnic minority population that includes sexual minorities includes sexual minorities
STUDY DESIGNSTUDY DESIGN
Prospective, longitudinal studyProspective, longitudinal study
Pre-post implementation Pre-post implementation evaluation evaluation
2-year timeline2-year timeline
STUDY POPULATIONSTUDY POPULATION
Sexual minorities, which can include…Sexual minorities, which can include…LesbiansLesbians
GaysGays
BisexualsBisexuals
TransgenderTransgender
IntersexIntersex
ARTC’s patient population is 48% Hispanic and ARTC’s patient population is 48% Hispanic and 42% 42%
African AmericanAfrican American
PRELIMINARY ACTIVITIESPRELIMINARY ACTIVITIES
Needs assessment surveys of Needs assessment surveys of stakeholders:stakeholders:
Sexual minority patientsSexual minority patients
Treatment staff (medical, counseling, social Treatment staff (medical, counseling, social service and case management staff)service and case management staff)
The surveys indicated clear interest by The surveys indicated clear interest by patients and staff in having programs for patients and staff in having programs for sexual minorities, and willingness by both sexual minorities, and willingness by both to participate in a research project to participate in a research project
HYPOTHESESHYPOTHESES
Participation by sexual minorities Participation by sexual minorities in specialized groups will result in specialized groups will result in:in:
Decreased substance abuse Decreased substance abuse
Improved Quality of LifeImproved Quality of Life
CURRICULUMCURRICULUM
MedicalMedical
Hormone therapy for transgender Hormone therapy for transgender patients patients
Referral for cosmetic and sex Referral for cosmetic and sex reassignment surgery reassignment surgery
LGBTI-specific healthcare services, LGBTI-specific healthcare services, including HIV-related servicesincluding HIV-related services
CURRICULUMCURRICULUM
Clinical (Psychological): Clinical (Psychological):
Process of “coming out”Process of “coming out”
Behavior modification interventions Behavior modification interventions to promote healthy lifestyle skills (i.e. to promote healthy lifestyle skills (i.e. HIV prevention and intervention to HIV prevention and intervention to promote safer sex/harm reduction)promote safer sex/harm reduction)
CURRICULUMCURRICULUM
Clinical (Psychological): Clinical (Psychological):
Definition of “self” as a sexual Definition of “self” as a sexual minorityminority
Building self acceptance and self-Building self acceptance and self-esteem; dealing with societal esteem; dealing with societal discrimination and stigma; issues discrimination and stigma; issues surrounding LGBTI Pride Week surrounding LGBTI Pride Week
CURRICULUMCURRICULUMSubstance Abuse: Substance Abuse: Drugs of abuse by LGBTI patientsDrugs of abuse by LGBTI patients
Relapse prevention; identifying triggersRelapse prevention; identifying triggers
Legal: Legal: Transgender legal rights issues (i.e. Transgender legal rights issues (i.e.
legal name change)legal name change)
Parenting; legal issues concerning child Parenting; legal issues concerning child custody and child abusecustody and child abuse
Housing issues and homelessness Housing issues and homelessness
MEASURESMEASURES
Substance AbuseSubstance Abuse
Serial toxicology screens and Serial toxicology screens and Composite International Diagnostic Composite International Diagnostic Interview (CIDI) assessments Interview (CIDI) assessments
Quality of LifeQuality of Life
Serial World Health Organization Quality Serial World Health Organization Quality of Life (WHOQOL) – BREF assessmentsof Life (WHOQOL) – BREF assessments
DomainDomain MeasureMeasure Data SourceData Source
Substance Substance AbuseAbuse
Toxicology screensToxicology screens Patient chartPatient chart
BreathalyzerBreathalyzer Patient chartPatient chart
CIDICIDI Patent Patent interviewinterview
Quality of LifeQuality of Life WHOQOL-BREFWHOQOL-BREF Patient Patient interviewinterview
DOMAINS, MEASURES DOMAINS, MEASURES & DATA SOURCES & DATA SOURCES
DATA ANALYSISDATA ANALYSIS
Quantitative analysis of each Quantitative analysis of each study measurestudy measure
Categorical variables: chi-Categorical variables: chi-square tests for statistical square tests for statistical significancesignificance
CURRENT STATUSCURRENT STATUSScientific Review Group (SRG) review: Scientific Review Group (SRG) review:
Not scored; SRG recommended Not scored; SRG recommended inclusion of control groupinclusion of control group
ARTC analysis of SRG review: Logistics ARTC analysis of SRG review: Logistics of control group deemed not of control group deemed not appropriate; too few subjects in each appropriate; too few subjects in each armarm
Next Steps: Submit to CSAT under Next Steps: Submit to CSAT under Targeted Capacity Expansion grant Targeted Capacity Expansion grant program in early 2008 program in early 2008