Current Projects.

The Bellwether Collaborative advances health justice through interdisciplinary scholarship, community-led partnerships, and solution-focused research initiatives. Explore recent and ongoing projects in our portfolio to learn more about how our research findings can support meaningful changes in our community.

The Crossroads Study

THE LEADERSHIP TEAM

MPI

Lauren Brinkley-Rubinstein

Duke University

MPI

Emily Dauria

University of Pittsburgh

MPI

Alysse Wurcel

Boston Medical Center

MPI

Kathryn Nowotny

University of Miami

CO-I

Catherine Paquette

Duke University

Background.

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Rationale.

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Study Population.

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Study Activities.

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DUKE RESEARCH TEAM

Margaret Roach

Clinical Research Coordinator, II

Asset

Background.

Structural racism shapes public safety, health, and housing outcomes in cities across the U.S. — a legacy visible in Durham, NC, from the destruction of Black Wall Street and the construction of the Durham Freeway through Black neighborhoods to present-day disparities in income, housing, and policing. Black residents in Durham are more likely to live in poverty, earn substantially less than white residents, and make up a disproportionate share of the city's unhoused population. These inequities intersect with the criminal legal system, where Black residents are disproportionately arrested, incarcerated, and placed under community supervision, with downstream harms to health, housing, and employment.

Rationale.

ASSET (Aligning Systems for Safety and EquiTy) is a RWJF Systems for Action study documenting, evaluating, and optimizing the Durham Community Safety Department's (DCSD) transformation from its original HEART model into a broader Safety Hub — a single city agency consolidating housing support, income assistance, harm reduction, survivor care, re-entry services, and behavioral health response. The project uses participatory, community-engaged methods to understand how this consolidation affects coordination, accessibility, and equity for historically marginalized residents. Findings will inform real-time improvements to DCSD's Safety Hub design and will be synthesized into a Blueprint — a practical, publicly shareable guide for other cities considering similar approaches.

Study Population.

Journey Mapping Participants:

12-18 adults who live in Durham, NC, who have used DCSD's expanded services

Systems and Data Mapping Participants:

Workshops with DCSD, local service providers (e.g., housing providers, public health, violence prevention, and healthcare representatives, behavioral health organizations), local policymakers, and community members living in Durham, NC

Stakeholder Interviews:

15 individuals who are DCSD program managers or departmental leaders, and 10 leaders or decision-makers in violence reduction efforts in Durham, NC

Study Activities.

The study team is conducting journey mapping sessions with individuals who have recently used DCSD's expanded services to understand first-hand experiences of navigating these systems.

In parallel, systems and data mapping workshops bring together DCSD staff, community partners, service providers, local policymakers, and community members to visualize service delivery and to identify opportunities for better alignment and data sharing across agencies.

Individual interviews supplement this understanding by providing a system-level view of how the Safety Hub model was designed, implemented, and adapted over time, and how it can be improved.

Crossroads

Background.

Overdose remains a leading cause of preventable death in the United States, with certain populations — including those with prior involvement in the criminal legal system — facing disproportionately elevated risk.

Community paramedic (CP) programs have launched nationally in response to the overdose epidemic. They are medically trained first responders who respond via 911 after an overdose call. CPs provide life-saving interventions (e.g., naloxone), medications for opioid use disorder (MOUD), and linkage to health services, with follow-up after the initial encounter.

Rationale.

CROSSROADS is a research hub of JCOIN 2.0, a NIDA research network at the intersection of substance use and the criminal legal system, focused on overdose prevention. While recent investments have focused on the treatment of people in jail and prisons, less work has examined how to deploy and optimize interventions at earlier points in the sequential intercept model, such as CPs, to prevent adverse substance use outcomes. Therefore, the aims of CROSSROADS are to develop, test, and optimize a community paramedic intervention via an application called Ito Health.

Study Population.

Aim 1 - Intervention Development:

External Advisory Boards with 20-24 representatives (5-6 at each site) with lived experience of substance use or overdose and professional experience with CP programs.

Aim 2 - Intervention Clinical Trial:

400 adults who have recently interacted with the CP program across four sites: Florida, Maine, North Carolina, and West Virginia.

Aim 3 - Implementation Evaluation:

40 professionals with experience with CP programs implementing CROSSROADS (10 at each site) and 60 participants (15 at each site) from the CROSSROADS intervention.

Study Activities.

In the first phase of the study, CROSSROADS works with External Advisory Boards (EABs) at each site to design the CROSSROADS intervention, using Human-Centered Design methods.

In the second phase of the study, participants will be randomly assigned to the control (CP Standard of Care) or treatment (CROSSROADS) groups, and the CROSSROADS intervention will be compared to CP Standard of Care on substance use and criminal legal system involvement outcomes.

The final study phase will involve qualitative interviews with individuals with professional experience implementing the CP programs and with individuals who participated in the CROSSROADS study to evaluate the implementation of the intervention.

FRI HEAL

Background.

There is a growing body of evidence supporting the effectiveness of opioid agonist pharmacotherapy for the treatment of opioid use disorders (OUDs) in jail and prison settings. However, many US prison and jail administrators remain reluctant to offer medication for OUDs (MOUDs) in their facilities, largely because of their preference for medication-free interventions, concerns about diversion, and regulations regarding opioid agonist treatment. This reluctance produces a significant gap between current practice and evidence-based care in justice settings.

Rationale.

Extensive evidence documents that continuity of substance treatment from jail to the community is associated with better treatment outcomes. Telemedicine provides a viable solution for healthcare and treatment gaps, breaking the significant barrier of geographic distance to promote equitable access, particularly in rural areas. Community pharmacies are an integral part of telemedicine treatments, yet buprenorphine access in pharmacies is often limited for patients with OUD, and stigma among pharmacists is frequently cited as a barrier. Understanding key implementation factors will aid in optimizing buprenorphine interventions in jail and pharmacy settings.

Study Population.

Carceral Staff Stakeholder Interviews:

Approximately 80 key stakeholders (n=10 at each of 8 participating rural jails in Maryland), including pharmacists, telemedicine providers, and jail administrators who are involved in the provision of extended-release buprenorphine implementation.

Pharmacist Stakeholder Interviews:

In addition to these 80 interviews, the study team will conduct qualitative interviews with a national sample of 50 key stakeholders, interviewing a pharmacist from each state on the provision of extended-release buprenorphine in carceral settings.

Study Activities.

The Duke team will conduct 60-minute qualitative interviews with key stakeholders to assess factors relevant to implementation and sustainability of the telemedicine buprenorphine intervention in jails and pharmacy settings. Interviews will explore topics including dose induction, telemedicine procedures, medication preferences, continuity of care, stigma, pharmacy procedures, and the cascade of care for substance use disorder. Findings will help guide other jurisdictions in the delivery of MOUDs for people prior to leaving jail settings and improve the transition to clinical care in the community.

Elevate

Background.

Firearm violence is a leading cause of death and injury in the United States, with nearly 47,000 deaths occurring in 2023 alone. While mortality data are well-established, far less is known regarding the burden of nonfatal firearm injury. Importantly, these injuries are experienced differently across populations, with Black Americans being disproportionately impacted. Survivors of firearm injury are at an increased risk of future gun violence, including an increased risk of death involving a firearm. Several program models have emerged nationwide to improve outcomes of survivors of firearm injuries, such as hospital-based violence intervention programs (HVIP).

Rationale.

HVIP services can include intensive case management, behavioral health support, safety planning, and connections to social services in order to address the structural and interpersonal determinants of conflict. Though these programs are promising, engagement in services is uneven. A critical, yet understudied, factor is the presence of law enforcement in emergency departments (EDs) which may erode trust, exacerbate trauma, and deter participation, particularly among Black and Latinx survivors. Little research has explored how law enforcement presence influences patient behavior, provider practices, and HVIP implementation, despite growing calls for trauma-informed, community-centered approaches to violence.

Study Population.

Research activities will take place across three sites: Pittsburgh, PA; Durham, NC; and Denver, CO.

Study Activities.

The study will involve three distinct research activities:

A targeted review of hospital documents to better understand the institutional context that shape HVIP operations.

Structured non-participant observation to examine how law enforcement presence in EDs affect healthcare delivery

Semi-structured interviews will be conducted with survivors of firearm injury (N = 15 per site), healthcare system partners (N = 15 per site), and law enforcement (N = 5 per site).

Interact Center

Background.

HIV is over-represented among people who use drugs and people involved in the criminal legal system. A strong toolkit of HIV prevention and treatment exists, but it is rarely delivered alongside substance use care for people moving between incarceration and the community, or designed with those communities as partners.

Rationale.

INTERACT is the patient engagement and resource center of CONNECT, a NIDA research network working to close gaps in HIV and substance use care for people involved in the criminal legal system. As the network's patient engagement center, INTERACT embeds people with “context expertise” (lived experience of the criminal legal system, HIV, and substance use) across CONNECT's research. Its central aim is to make lived expertise a permanent, structural feature of a national HIV and substance use research network.

Interact Center Activites.

A Community Advisory Board of context experts co-leads INTERACT's work: using human-centered design to document experiences with HIV and substance use care and identify strategies to improve it, co-leading pilot studies that test the feasibility and acceptability of those strategies, and evaluating how well the Center sustains the meaningful inclusion of context experts across the network.

Notre

Background.

Co-occurring opioid use disorder (OUD) and HIV risk behaviors among incarcerated individuals represent a major syndemic. Approximately 17% of incarcerated people have OUD, and HIV prevalence in carceral settings is three to five times higher than in the general population. While highly effective interventions exist, including HIV pre-exposure prophylaxis (PrEP) and medications for opioid use disorder (MOUD), they remain underutilized and often face adherence barriers during community re-entry.

Rationale.

Although oral PrEP and sublingual buprenorphine (SL-B) are difficult to maintain during re-entry due to structural barriers, newly FDA-approved long-acting injectable (LAI) formulations for both HIV prevention (e.g., Apretude) and OUD treatment (e.g., XR-B, Brixadi) offer a promising opportunity. While integrating HIV and MOUD services improves clinical outcomes, implementation strategies designed for general community settings often fail in carceral contexts. NOTRE addresses this gap by conducting a hybrid implementation-effectiveness type 2 trial to evaluate implementation strategies and test the comparative effectiveness of a co-located LAI PrEP and XR-B patient preference intervention for individuals transitioning from carceral facilities to the community.

Study Population.

Aim 1 (Intervention Protocol Development):

36 expert stakeholders, clinic staff, and currently or recently incarcerated individuals across Washington, D.C., Prince George’s County, MD, and Montgomery County, MD.

Aim 2 (Implementation Facilitation):

150 staff members and service providers (including carceral facility staff, community MOUD/HIV providers, and re-entry organization staff) across the target regions. A subset of 45 stakeholders will complete qualitative interviews.

Aim 3 (Patient Preference Trial):

450 adults (18+) with OUD diagnosis who are HIV-negative, PrEP-indicated, and within 120 days of release from partner carceral facilities in Washington, D.C., Prince George’s County, MD, or Montgomery County, MD.

Study Activities.

In the first phase (Aim 1), the NOTRE study team is interviewing jail and clinic staff, re-entry stakeholders, and currently or recently incarcerated individuals to design and refine intervention protocols for co-locating long-acting injectable MOUD and PrEP. In the second phase (Aim 2), the study team will evaluate implementation facilitation by collecting quantitative surveys (n=150 at early and late implementation) and qualitative interviews (n=45 across early, mid, and late stages) from carceral and community staff to assess feasibility, acceptability, adoption, and organizational climate. In the third phase (Aim 3), the research team will conduct a patient-preference trial to evaluate co-located care among 450 individuals leaving jail. With the patient-preference design, participants will choose their preferred formulation (long-acting injectable vs. oral/sublingual) for both MOUD and PrEP. Participants will initiate MOUD in jail, transition to partnering community clinics post-release for co-located PrEP initiation and MOUD continuation, and complete longitudinal follow-ups over 12 months to assess medication adherence, clinical outcomes, and re-entry success.

The Interact Center

THE LEADERSHIP TEAM

MPI

Lauren Brinkley-Rubinstein, PhD

Duke University

MPI

Emily Dauria, PhD

University of Pittsburgh

Background.

HIV is over-represented in substance using and criminal legal involved populations. The syndemic risks for incarceration and HIV risk and acquisition are strongly correlated as a result of both structural and individual level factors. While effective HIV prevention strategies exist, they are rarely adapted or deployed with people in jails, prisons, during re-entry, or on community supervision. And, when they are, equal collaboration with the community to develop and implement intervention strategies is often missing. Improving meaningful representation of individuals with expertise based on lived experience, can improve the effectiveness, relevance, validity, and acceptability of health research and service delivery systems.

Overview.

The INTERACT Center is a Patient Engagement Resource Center developed under the Ending the HIV Epidemic initiative, The goal of the center is to improve representation and engagement in research of people with lived expertise, including those with exposure to the criminal legal system, people with a history of substance use, and those living with HIV. By elevating and leveraging the expertise of these populations, the INTERACT Center aims to illuminate key barriers to service access and utilization and identify and test potential solutions that are human-centered, scalable, and replicable.

DUKE RESEARCH TEAM

Madelene Travis, BA

Clinical Research Coordinator, Sr.

INTERACT CENTER CORES

Community Engagement Core

The Rapid Response & Pilot Core will cultivate innovative clinical, translation, and community engaged research by supporting new initiatives driven by participatory methods

Capacity Engagement Core

The Capacity Building Core will develop training plans to be responsive to the INTERACT CAB as well as activities planned as part of regional research hub projects.

Administrative Core

The Administrative Core provides leadership and coordination for the Center, including supporting overall program management and network communication.

Rapid Response & Pilot Core

The Rapid Response and Pilot Core will cultivate innovative clinical, translation, and community engaged research by supporting new initiatives driven by participatory methods.

Tracking & Evaluation Core

The Tracking & Evaluation Core will report on the efficacy and impact of the Interact Center.

Dissemination Core

The Dissemination Core will lead the translation of findings and accessible packaging of solutions for diverse audiences (e.g., policy makers, stakeholders, etc.)