#IChampionHealth: Supporting Substance Misuse Prevention Through Peer Networks and a Trauma-Informed Health Equity Lens

#IChampionHealth: Supporting Substance Misuse Prevention Through Peer Networks and a Trauma-Informed, Health Equity Lens Abstract Background. Families and communities across the US have been devastated by the ready availability of dangerous synthetic opioids such as fentanyl, at a time when formal and informal protective support networks are slowly rebuilding due to the disruption caused by the pandemic. Furthermore smoking, illicit and unprescribed drug use, and alcohol use rank as the second, eighth, and twelfth contributors, respectively, to mortality in the U.S., totaling close to 700,000 deaths per year. These estimates do not include the additional contribution that these substances make to the country’s morbidity and social and economic burden on families and communities The recently released National Drug Control Strategy (2022) from the White House Office of National Drug Control Policy (ONDCP) lays out a comprehensive plan to, not only enhance access to treatment and increase harm reduction strategies, but also increase implementation of evidence-based prevention programming at the community level. The 2022 National Drug Control Strategy discusses prevention under “Prevention and Early Intervention,” stating, “ensuring that school-aged children have access to universal prevention programs designed to prevent use before it starts, prevention services that focus on children at higher risk for use or those that have started using drugs, and when necessary provide referral to treatment and recovery support is essential to support the health, well-being, and futures of the Nation’s 74 million children” (p.21). Systematically addressing conditions known to increase liability for behavioral problems among vulnerable populations and building supportive environments that foster resiliency are strategies consistently found to avert trajectories away from substance use in general and substance use disorders (SUD) in general, and opioid use disorder (OUD) in particular. Investments in this approach are expected to result in significantly lower rates of SUD and other related behavioral and mental health issues in current and subsequent generations of youth and, therefore, will reduce the burden on our communities in terms of lowered social and health systems involvement, treatment needs, and productivity. Attention to these childhood and adolescent prevention approaches should be considered as part of the response to the US opioid crisis. However, less is known how to operationalize this approach, particularly given the need for community buy in and culturally tailored strategies and prevention programming. The overarching purpose of the #IChampionHealth project is to mobilize intergenerational community champions to reduce substance use among diverse communities, promote access to trauma-informed mental health services, and improve health equity in Kentucky communities. The major goals of the project are to engage, educate, and empower by: 1) Engaging partners to expand the capacity and infrastructure of existing substance misuse and mental health prevention coalitions representative of diverse communities across Kentucky to promote access to trauma-informed mental health services; 2) Educating 6th - 12th grade youth through a culturally tailored and evidence-informed school- based peer substance misuse prevention initiative; and 3) Empower intergenerational champions representative of diverse communities using a train- the-trainer trauma-informed prevention approach to sustain community engagement in substance misuse prevention. Approach. We will identify and work with at least two community partners/coalitions to support the development of tailored community action plans. We plan to engage, educate, and empower intergenerational teams that represent and give voice to diverse communities in Kentucky during the project. These teams, led by community health champions, will work in tandem with existing substance use prevention/mental health coalitions to champion substance use prevention across the Commonwealth. We will conduct evidence-based prevention and trauma-informed training with each of the coalitions and intergenerational teams. Champions will receive education to support best practices for substance use prevention with a trauma and equity-informed lens. This approach will ultimately strengthen intergenerational community leaders who serve, represent and give voice to diverse community sectors to reduce substance use and promote health equity. Moreover, creating an intergenerational model that explicitly engages individuals across the lifespan, including youth and older adults, in prevention efforts will increase sustainability and long-term capacity. Our team has experience with all components of this approach but integrating intergenerational community-led teams as leaders in substance use prevention specifically is a novel strategy with broad application. Building on our prior success with #iCANendthetrend, an evidence-informed peer tobacco prevention initiative that has reached more than 25,000 Kentucky youth since 2019, we will develop more broad reaching substance use prevention education to be inclusive of other substances using a near peer model, which will support statewide capacity for school- and community level intervention. To support sustainability of substance use prevention efforts and to also support adult-youth partnerships, we will recruit, train, and mobilize a cohort of 10-15 adult and youth Community Health Champions. Our proposal seeks to build on the research- informed approach that finds a connection to a caring adult is a primary protective factor against a range of adolescent risk behaviors, including substance use, across youth with diverse racial, ethnic, economic, and geographic backgrounds. To do this, the program aims to not only connect youth with near-peer college mentors but to build youth-adult relationships through capacity building and our intergenerational Community Health Champion model. Evaluation will be essential in ensuring the #IChampionHealth project implements with a high degree of quality and responsiveness, meets its objectives, and achieves its goals. Our team will conduct both the formative and summative evaluation. The evaluation questions seek to provide information on project quality (Q), effectiveness (EC), efficiency (EF), and equity (EQ). Each evaluation activity will utilize quantitative and qualitative data to answer questions and examine project fidelity and outcomes. Qualitative methods will include (1) focus groups and interviews with (a) coalition members and partners, (b) community champions and members, as applicable, and (c) program developers. Data will be collected from each group annually with data collection protocols developed to align with questions within each evaluation activity. Quantitative metrics will include (1) external metrics, (2) community partner engagement, (3) annual surveys of community partners and champions, and (4) pre- and post-activity surveys. External metrics include (a) metrics from statewide health behavior data (KIP, YRBS, BRFFS). Community partner engagement data include (a) program-collected metrics on coalition engagement activities (e.g. attendance, number of partners/sectors represented, etc.) and (b) supporting documentation of program activities (e.g. community action plan). Annual Survey data will be collected from community health champions and will (a) measure growth in knowledge and skills, (b) gather feedback on project implementation, (c) collect fidelity-focused metrics of participation, (d) gather demographic data to assist in examining impact of activities and (e) gather summative impact data related to participant actions taken as a result of participation in the activities. Pre- and post-activity surveys will document participation in professional development workshops and school-based educational sessions, to assess change in knowledge, attitudes, and awareness of substance use harm perceptions and access to resources. Analytic methods are selected to match the evaluation purposes and questions, but for every question, a range of data sources are used to provide sufficient evidence to support conclusions. Quantitative data are analyzed using both traditional (descriptive analysis, univariate and bivariate analysis, etc.) and novel approaches (e.g., Rasch measurement). Analytical software used may include DeDoose, SPSS, and R.