Abstract: Harnessing the Clinician-Researcher Role: Rapid Qualitative Observations and Resultant Adaptations from the Emergency Department Longitudinal Integrated Care (ED-LINC) Randomized Clinical Trial (Society for Social Work and Research 28th Annual Conference - Recentering & Democratizing Knowledge: The Next 30 Years of Social Work Science)

Schedule:

Sunday, January 14, 2024

Independence BR A, ML 4 (Marriott Marquis Washington DC)

* noted as presenting author

Kayla Lovett, MSW, LSWAIC, Social Worker, Department of Emergency Medicine, University of Washington, WA

Lauren Whiteside, MD, Associate Professor, Department of Emergency Medicine, University of Washington, WA

Lawrence Palinkas, PhD, Albert G. and Frances Lomas Feldman Professor of Social Policy and Health Fellow, University of Southern California, CA

Craig Field, PhD, Professor, Department of Psychology, University of Texas at El Paso, TX

Michael Light, LCSW, MPH, Co-Director & Core Faculty, Palliative Care Training Center, University of Washington, Seattle, WA

Mark McGovern, PhD, Professor, Psychiatry and Behavioral Sciences, Stanford University, CA

Caleb Banta-Green, PhD, MPH, MSW, Acting Professor, Addictions, Drug & Alcohol Institute, Department of Psychiatry & Behavioral Sciences, UW School of Medicine, University of Washington, WA

Douglas Zatzick, MD, Professor, Department of Psychiatry and Behavioral Sciences, University of Washington

Background and Purpose: The landscape of work can change quickly in the timeline of intervention research. The Emergency Department Longitudinal Integrated Care (ED-LINC) randomized trial utilizes a social work-led collaborative care intervention for patients with opioid use disorder (OUD) in the Emergency Department (ED). ED-LINC intervention conceptualization took place prior to COVID and the rise of fentanyl. In the ED-LINC pilot phase, 90% of participants used heroin while most current ED-LINC intervention participants endorse fentanyl use. This investigation aims to describe a systematic rapid qualitative approach positioning clinicians on the research team as participant-observers during routine patient care, documenting reflections and adapting protocol and intervention design in real-time.

Methods: The interdisciplinary ED-LINC intervention team regularly discussed clinical observations and necessary real-time unplanned modifications to the intervention during clinical case conferences. Utilizing the Rapid Assessment Procedure Informed Clinical Ethnography (RAPICE) method, staff reflected on the feasibility, utility, and saliency of the planned and piloted intervention given the current landscape and changing patient needs. As clinician-researchers, the team worked with qualitative content experts to analyze RAPICE reflections and adapt the ED-LINC intervention and study protocol.

Results: From 4/12/2022 to 11/30/2022, 30 patients at Harborview Medical Center were recruited and randomized to the EDLINC intervention. Thematic analysis of RAPICE reflections from this initial sample of intervention participants revealed five domains for adaptation: 1) suicide risk assessment and safety planning, 2) engagement as a targeted piece of intervention, 3) a patient-driven and component-based intervention design, 4) MOUD discussion and approach, and 5) collaborative care framework using measurement-based care. Presented themes informed adaptation of ED-LINC from a stepped-care intervention assuming desire for treatment to a harm-reduction-oriented component-based design anchoring on individualized goal-planning. RAPICE themes also prompted the study team to include innovative fentanyl-based measures in longitudinal outcome data and expanded suicide risk assessment procedures to include specific overdose prevention dimensions.

Conclusions and Implications: The traditional knowledge creation processes in intervention research are proving less effective in a world of rapidly developing crises such as the opioid epidemic. Given the evolving social landscape, the ways of harnessing the clinician-researcher role within teams of investigators who are also involved in direct care deserve additional attention. Rapid assessment procedures like RAPICE provide a structure for making timely adaptations to ensure that study interventions and protocols produce salient and generalizable results.