This study will explore how to expand the Just Care for Families (JCFF) program beyond its current sites in Oregon, while addressing two main challenges: the developer team cannot provide ongoing support to every new program, and rural counties face limits on caseloads and reimbursement because of long travel distances. To overcome these barriers, the trial will test two strategies-using a JCFF mobile app to improve outcomes and efficiency, and relying on trained Experts (instead of the developer team) to guide new counties. With five active counties and four new ones, researchers will study whether parents receiving JCFF with digital support show reduced opioid and stimulant use, better child welfare outcomes like reunification, and more efficient treatment. This study will also compare how well new counties implement JCFF compared to existing ones, and use modeling to see if digital tools help programs sustain themselves by balancing caseloads and reimbursement. This study is supported by and included in the Helping to End Addiction Long-term Initiative (https://heal.nih.gov/).

This Hybrid Type II effectiveness-implementation trial uses an adaptation of a stepped-wedge design to test clinical outcomes spanning interception points within the Child Welfare system and implementation outcomes when Just Care for Families (JCFF) is delivered with the addition of a mobile App with provider feedback about parent App usage. Nine rural Oregon counties, five active counties previously implemented with developer support, and four new counties that will implement with new JCFF Expert support have been recruited to test the clinical effectiveness of JCFF when delivered with and without the App. A total of 254 parents with opioid and/or stimulant use and intersection with the Child Welfare system will be recruited to participate. Parents will receive usual services, JCFF, JCFF with the App, or JCFF with the App and feedback. Longitudinal in-person assessments at baseline, 4-months, 9-months, 14-months, and 18-months, and weekly text assessments of social determinants of health needs and Child Welfare intersection will test the reduction in parent opioid and stimulant use over time with increased treatment engagement, retention, completion and decreased length of Child Welfare case, reentry into treatment, and recidivism (arrest, Child Welfare re-referral). The effectiveness of the JCFF implementation approach will be tested when implemented with the support of new JCFF Experts versus developer Experts, with the aim of equal effectiveness. Clinical and implementation outcomes will be modeled to examine the impact that adding the App could have on program sustainment for rural programs, expanding the potential for JCFF to scale up in Oregon and elsewhere, positioning for public health impact. This study is supported by and included in the Helping to End Addiction Long-term Initiative (https://heal.nih.gov/).

Inclusion Criteria:

• Misuse of opioids and/or stimulants in the last year, including misuse of prescriptions
• parent of a child aged 0-18 with the child living in the home or a reunification plan in place
• residing in one of the nine participating counties
• insured by Medicaid
• access to a computer, smartphone, or wireless/cellular connection if a device were to be provided
• Willing to enroll with the first available Just Care coach

Exclusion Criteria:

-- Alcohol use disorder

All collected IPD except for administrative data will be shared. For administrative data, a data use agreement signed by the research team and members of the third party will define the scope of appropriate access and use of the data. While overall or composite scores may be available to share publicly, ethical and legal considerations limit distribution of individual level data.

Beginning 6 months after closing baseline data collection with no end date

Data will be shared in accordance with the NIH Helping to End Addiction Long-term (HEAL) Initiative Public Access and Data Sharing Policy. All data will be submitted to the NAHDAP repository and will be findable and accessible through the HEAL Initiative Data Ecosystem. All data will also be submitted to the NIDA-funded Methodology and Advanced Analytics Resource Center (MAARC) located at the University of Chicago, a data commons built for the purpose of sharing research data collected by research "hubs" within the NIDA-funded Justice Community Overdose Innovation Network (JCOIN). Data will be shared with investigators working under an institution with Federal Wide Assurance (FWA) and could be used for secondary study purposes. Requested primary study data and metadata (e.g., format and organization) will be made available to investigators according to the policies of the University of Chicago MAARC and the NAHDAP repository.