Project Grant R01MH137237

HYBRID EFFECTIVENESS-IMPLEMENTATION TRIAL TO EVALUATE A SCALABLE, PEER-DELIVERED INTERVENTION FOR DEPRESSION AMONG PEOPLE WITH SUBSTANCE USE DISORDER IN A CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINIC - LOW-INCOME, RACIAL/ETHNIC MINORITIZED INDIVIDUALS, ESPECIALLY PEOPLE OF COLOR LIVING IN IMPOVERISHED COMMUNITIES, HAVE LIMITED ACCESS TO EVIDENCE-BASED INTERVENTIONS (EBIS) FOR MENTAL HEALTH YET ALSO EXPERIENCE GREATER PSY- CHIATRIC AND MEDICAL COMORBIDITIES AND POORER TREATMENT OUTCOMES COMPARED TO HIGHER-INCOME, WHITE COUNTER- PARTS. ALARMINGLY, RATES OF MAJOR DEPRESSIVE DISORDER (MDD) AND SUBSTANCE USE DISORDER (SUD) HAVE RISEN SIG- NIFICANTLY FOR BLACK ADULTS OVER THE PAST TWO DECADES, PARTICULARLY INDIVIDUALS LIVING IN POVERTY, RESULTING IN DISPRO- PORTIONATELY WORSENING CLINICAL AND FUNCTIONAL OUTCOMES. THERE IS A PRESSING NEED TO DISSEMINATE EBIS FOR MDD- SUD THAT ARE ACCEPTABLE, SCALABLE AND SUSTAINABLE IN TRADITIONALLY UNDERSERVED SETTINGS, INCLUDING CERTIFIED COM- MUNITY BEHAVIORAL HEALTH CLINICS (CCBHCS) WHICH SEEK TO EXPAND ACCESS TO SERVICES IN SOCIOECONOMICALLY DIS- ADVANTAGED AREAS. PEER RECOVERY SPECIALISTS (PRSS), INDIVIDUALS IN RECOVERY FROM SUD, HAVE PROMISE FOR IN- CREASING ACCESS TO EBIS AND ARE WIDELY EMPLOYED IN CCBHCS; YET, FEW STUDIES HAVE EVALUATED THE CLINICAL EF- FECTIVENESS, IMPLEMENTATION, AND COST-EFFECTIVENESS OF PRS-DELIVERED EBIS, EVEN AS PRS MODELS ARE RAPIDLY SCALING IN THE US. PRELIMINARY DATA: PIS FELTON AND MAGIDSON HAVE LED TWO OPEN-LABEL TRIALS DEMONSTRATING THE FEASIBILITY, ACCEPTABILITY, AND PRELIMINARY EFFECTIVENESS OF A PRS-DELIVERED MODEL (PEER ACTIVATE) TO IMPROVE MDD AND SUD OUTCOMES AMONG LOW-INCOME, PREDOMINANTLY BLACK INDIVIDUALS IN TRADITIONALLY UNDERSERVED AREAS. THE TEAM HAS SHOWN THAT BEHAVIORAL ACTIVATION (BA), AN EBI BASED ON REINFORCEMENT THEORY AND FOCUSED ON SCHED- ULING OF VALUED, ADAPTIVE BEHAVIORS IS PARTICULARLY SUITABLE FOR PRS DELIVERY AND PROMISING TO ADDRESS GAPS IN EBI ACCESS. PRELIMINARY STUDIES ESTABLISHED THE FEASIBILITY AND ACCEPTABILITY OF THIS APPROACH; NEXT STEPS ARE TO CON- DUCT A LARGE-SCALE RANDOMIZED TRIAL TO EVALUATE CLINICAL AND COST EFFECTIVENESS, TEST POTENTIAL MODIFIABLE MECHA- NISMS OF TREATMENT EFFECTIVENESS, AND EVALUATE LONGER-TERM IMPLEMENTATION. METHODS: WE PROPOSE TO EVALUATE PEER ACTIVATE IN A FULLY-POWERED RANDOMIZED HYBRID TYPE 1 EFFECTIVENESS-IMPLEMENTATION TRIAL (N=200) IN A HIS- TORICALLY UNDERSERVED SETTING IN DETROIT, MI. LEVERAGING A WELL-ESTABLISHED PARTNERSHIP WITH A COMMUNITY-BASED, PRS-LED CCBHC, WE WILL COMPARE PEER ACTIVATE TO ENHANCED TREATMENT AS USUAL (ETAU; NON-SPECIFIC, PRS- DELIVERED SUPPORTIVE CARE) ON DEPRESSIVE SYMPTOMS (PRIMARY) AND SUBSTANCE USE (AIM 1), AND EVALUATE POTENTIAL MECHANISMS OF THIS APPROACH (ENVIRONMENTAL REWARD; AIM 2). GUIDED BY THE EPIS FRAMEWORK AND PROCTOR'S MODEL, WE WILL EVALUATE LONGER-TERM IMPLEMENTATION OUTCOMES (AIM 3), INCLUDING COST EFFECTIVENESS. A COMMUNITY ADVISORY BOARD WILL GUIDE ALL ASPECTS OF THE TRIAL TO PROMOTE THE POTENTIAL FOR SUSTAINABILITY. IMPACT: OUR PROPOSAL IS CONSISTENT WITH THE GOALS OF PAR-21-130, NIMH STRATEGIC OBJECTIVES TO DEVELOP INNOVATIVE SERVICE DELIVERY MODELS FOR LOW-INCOME, BLACK INDIVIDUALS WITH MENTAL HEALTH AND SUD COMORBIDITY, AND NOT-MH-22-170 PROMO- TION OF PARTNERSHIPS BETWEEN ACADEMIC INSTITUTIONS AND CCBHCS. FINDINGS HAVE THE POTENTIAL TO INCREASE AVAIL- ABILITY OF SUSTAINABLE EBIS FOR MENTAL HEALTH AND SUD COMORBIDITY IN UNDERSERVED COMMUNITIES.