Justice Community Overdose Innovation Network II TCU Hub (JCOIN II TCU)

Justice Community Overdose Innovation Network II TCU Hub: TCU Building Resilient Initiatives for Deflection Through Greater Engagement Project (TCU BRIDGE to Deflection Project)

The current study proposes to use a Hybrid Type 3 implementation research strategy to: 1) Significantly enhance our understanding of public health outcomes [e.g., overdose incidents and substance-use (SU)-related Emergency Medical Service (EMS) contacts] and public safety outcomes (e.g., drug-related arrests) associated with Deflection and Pre-Arrest Diversion initiatives (DPAD, hereafter referred to as Deflection); and 2) Create a lasting contribution to the fields of research focused on SU and the criminal legal system (CLS) by advancing knowledge of effective implementation strategies involving the critical role of community engagement in Deflection. The highly experienced team of Multiple PIs, senior-level collaborators from both Deflection and Community Behavioral Health (CBH), state-level evaluation partners, a national stakeholder advisory group, and CLS and behavioral health partners within each community have teamed up to carry out the proposed project. The study approach uses a hybrid implementation-effectiveness design to examine strategies to improve opioid and stimulant relevant outcomes, and specifically proposes to test the implementation-effectiveness of 2 strategy bundles to promote Deflection models through a CORE community engagement bundle (designed to facilitate community stakeholder engagement) and ENHANCED community engagement bundle (CORE plus a component to systematically involve community advocates) on improving implementation as well as public safety and health outcomes. The proposed randomized control trial includes a total of 20 geographically distinct clinical research performance sites (i.e., 20 communities spanning 5 states; New Mexico, Illinois, Wisconsin, Colorado, and Pennsylvania), with 3-5 communities per state and the inclusion of key CLS and CBH stakeholders within each site. The large scope of the project will maximize potential generalizability of study results and sustainability of implementation strategies.

Study Overview

• Status: Not yet recruiting
• Conditions: Drug Overdose; Criminal Behavior; Substance Use Disorder (SUD)
• Intervention / Treatment: Other: Core-interagency community engagement approach; Other: Enhanced-Core plus community engagement specialist

• Study Type: Interventional
• Enrollment (Estimated): 1620
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Amanda W Sease, Ph.D.; Phone Number: 817-257-5841; Email: a.wiese@tcu.edu

Study Locations

• United States
  • Texas
    • Fort Worth, Texas, United States, 76109
      • Texas Christian University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Staff

Inclusion Criteria:

• Directly involved in Deflection services, including:
• Making referrals (e.g., law enforcement, first responders, community agencies) & Providing services to participants (e.g., case managers, peer specialists, coordinators);
• Aged 18 years or older;
• Able to complete surveys in English;
• Willing to provide informed consent

Exclusion Criteria:

• Not affiliated with a participating Deflection agency;
• No role in Deflection referral or service delivery;
• Under age 18;
• Unable or unwilling to provide informed consent

Clients

Inclusion Criteria:

• Aged 18 years or older;
• Enrolled in a Deflection program within a participating community;
• Between 1 and 12 months post-enrollment at time of recruitment;
• Documented history of substance use disorder (SUD) or risk for SUD;
• Priority for individuals reporting opioid and/or stimulant use within the past year;
• Able to complete survey and/or interview; Willing to provide informed consent

Exclusion Criteria:

• Under age 18;
• Not enrolled in a Deflection program;
• Insufficient exposure to Deflection (<1 month);
• Unable or unwilling to provide informed consent

Citizens

Inclusion Criteria:

• Aged 18 years or older;
• Resident of a participating community;
• Represents general community population (including individuals with or without lived experience of SUD/CLS involvement);
• Able to participate in: Surveys and/or Community Listening Sessions;
• Willing to provide informed consent

Exclusion Criteria:

• Under age 18;
• Not residing in a participating community;
• Unable or unwilling to provide informed consent

Workgroup

Inclusion Criteria:

• Aged 18 years or older;
• Identified as a community or agency leader/stakeholder involved in Deflection programming;
• Member of a DAG within a participating community;
• Represents one of the required stakeholder roles: Law enforcement leadership or staff, Behavioral health leadership or staff Health professional, Community representative (citizen);
• Able to participate in meetings, surveys, and/or focus groups;
• Willing to provide informed consent

Exclusion Criteria:

• Not part of a DAG in a participating community;
• Does not hold a role relevant to Deflection leadership or decision-making;
• Under age 18;
• Unable or unwilling to provide informed consent

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: Core-interagency community engagement approach; facilitated public health-public safety interagency collaboration, best practices on building community engagement, and cross-system data driven learning	Other: Core-interagency community engagement approach; community engagement approaches that including building interagency collaboration, strategic planning, advocacy
Other: Enhanced-Core plus community engagement specialist; core plus strategic role development and coaching of known and trusted citizens to serve as Community Advocates in promoting community support of deflection efforts and fully engage in deflection leadership decisions	Other: Enhanced-Core plus community engagement specialist; community engagement approaches that include the core, plus promoting identification and full integration of community citizens in community engagement practices

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
public health and safety collaboration	Is there a change in public health and safety collaboration? Measured using the Brewer et al., 2018 survey on aligning strategy (e.g., work together to identify unmet needs in the community) and coordinating current work (e.g., share information that helps the system of care work better). The Brewer et al. (2018) Aligning Strategy and Coordinating Work Survey is measured on a 5-point Likert scale, and scores are computed by averaging all items within each scale to yield a mean. Higher scores = stronger collaboration / alignment / coordination	Month 10, 26, and 38 for Wave1; Month 14, 30, and 42 forWave 2
citizen awareness and perceived utility of Deflection	Is there a change in citizen awareness and perceived utility of Deflection? Measured using several survey measures on attitudes toward deflection efforts and law enforcement within their community, including awareness, acceptability, appropriateness, and feasibility. Survey measures are scored via averaging scale items together to yield a mean, with higher scores indicating higher levels of awareness, acceptability, appropriateness, and feasibility.	Month 10, 26, and 38 for Wave1; Month 14, 30, and 42 forWave 2
deflection workforce referrals and citizen enrollments in Deflection	Is there a change in workforce referrals and citizen enrollments in Deflection? Measured using existing data collected by the deflection program on referral and enrollments to deflection services including adoption (e.g., proportion of workforce and agencies referring clients to deflection), penetration (e.g., count of deflection referrals and enrollments), equity (e.g., proportion of referrals and enrollments of minority representation), and sustainment (e.g., continued adoption and penetration). Scores for each will be represented by a count/number.	Month 10, 26, and 38 for Wave1; Month 14, 30, and 42 for Wave 2
overdose and SU related mortality	Is there a change in overdose and SU related mortality rates? Measured using the National Association of State EMS Officials (NAEMSSO) harmonized data as collected from EMS agencies within the 5 participating states, as well as through coroner/vital statistics records on cause of death information for the communities. Rates are represented by a count/number of overdoses and SU related mortality rates, before and after implementation.	Month 4-38 for Wave 1; Month8-42 for Wave 2
service access along the full substance use cascade	Is there a change in service access along the full substance use cascade and complex needs? Measured through data sharing of existing records from deflection programs. Numbers/counts will be used to measure each step of the substance use cascade.	Month 4-38 for Wave 1; Month8-42 for Wave 2

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
deflection workforce attitudes toward deflection	Is there a change in deflection workforce attitudes toward deflection? Measured using the Donnelly et al. (2024) Tough on Crime Index and the Bailey et al. (2024) Stigma and Policing Attitudes Toward PWUD Scale, items are rated on Likert-type scales and averaged to create composite scores, with higher values indicating stronger endorsement of punitive ("tough on crime") attitudes and greater stigma toward people who use drugs and restrictive policing approaches.	Month 10, 26, and 38 for Wave1; Month 14, 30, and 42 forWave 2
citizen ratings of community law enforcement trust	Is there a change in community-law enforcement trust? Measured using the Hamm et al. (2018) Community-Law Enforcement Trust Scale, items are rated on Likert-type scales and averaged to create a composite score, with higher values indicating greater perceived trust between community members and law enforcement.	Month 10, 26, and 38 for Wave1; Month 14, 30, and 42 forWave 2

Collaborators and Investigators

• Sponsor: Texas Christian University
• Collaborators: National Institute on Drug Abuse (NIDA)
• Investigators: Principal Investigator: Jennifer E Becan, Ph.D., Texas Christian University; Principal Investigator: Kevin Knight, Ph.D., Texas Christian University

Publications and helpful links

General Publications

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Study record dates

Study Major Dates

• Study Start (Estimated): July 1, 2026
• Primary Completion (Estimated): March 1, 2029
• Study Completion (Estimated): May 1, 2029

Study Registration Dates

• First Submitted: March 30, 2026
• First Submitted That Met QC Criteria: April 7, 2026
• First Posted (Actual): April 14, 2026

Study Record Updates

• Last Update Posted (Actual): April 14, 2026
• Last Update Submitted That Met QC Criteria: April 7, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: deflection; pre-arrest diversion
• Additional Relevant MeSH Terms: Drug Misuse; Mental Disorders; Chemically-Induced Disorders; Prescription Drug Misuse; Behavior; Substance-Related Disorders; Drug Overdose; Criminal Behavior
• Other Study ID Numbers: 1RM1DA064502 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No