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Background For nearly two decades, it has been widely recognized that individuals in jail settings have a high prevalence of opioid use disorders (OUD) and are highly susceptible to fatal overdose upon their release. This setting provides a public health opportunity to address OUD with Medication for Opioid Use Disorders (MOUDs). Yet, 56% of jails do not provide MOUD, creating a pressing need for better implementation approaches in jail and the hand-off to the community. Two successful implementation strategies, NIATx external coaching and the Extension for Community Healthcare Outcomes (ECHO) case management telementoring model, were compared to address this persistent treatment gap. Methods This 2 × 2 design compared high ( n  = 12) and low ( n  = 4) dose coaching with and without ECHO in a 12-month intervention and 12 M sustainability period. The national trial included 25 jails and 13 community-based partners. MOUD trends for buprenorphine, methadone, injectable naltrexone, and combined MOUD between the study arms were assessed. Results Jail sizes ranged from 24% with < 100 and 24% with > 500 daily population, and community-based treatment providers ranged from 63% with < 50 and 7% with > 500 average monthly OUD intakes. New patient counts were found to significantly increase across the intervention phase for buprenorphine ( p  < .01) and combined MOUD ( p  < .01). Injectable naltrexone and methadone showed no consistent, significant gains. For sites with low coaching without ECHO, new patient counts for combined MOUD were predicted to increase by 47.44% during the intervention phase and 7.30% during the sustainability phase. ECHO demonstrated that MOUD use did not significantly increase compared to coaching across MOUDs in the intervention phase ( p  = .517). High- and low-dose coaching showed no significant differences in MOUD use during the intervention phase ( p  = .124). Conclusions Coaching emerged as a more effective implementation strategy than ECHO for increasing buprenorphine use in jail settings. In practice, ECHO sessions offered considerable overlap with coaching strategies. While high-dose coaching had greater gains for MOUDs overall than low-dose coaching, those gains were statistically insignificant, suggesting low-dose coaching to be more economical. To increase MOUD use in jail settings, jurisdictions should focus on new MOUDs so all three MOUDs are available and enhance the post-incarceration continuum of care. Trial registration Name of registry: ClinicalTrials.gov. Trial registration number: NCT04363320. Date of registration: 2020–07-30. URL of trial registry record: https://clinicaltrials.gov/study/NCT04363320?term=molfenter&rank=7 .

Background/Objectives: Parenting interventions are an effective way to support child development, and brief screening tools can support equitable implementation of parenting interventions by reducing program costs, increasing accessibility, and engaging populations who have traditionally been underserved. However, brief assessments are frequently overlooked and underutilized. The Family Check-Up (FCU) Online is a digital parenting intervention that integrates a brief FCU Online Assessment, feedback, and parenting skills via an app along with optional provider support. To date, no prior work has validated the FCU Online Assessment. Method: The current study combined two samples of parents participating in FCU Online studies and assessed: (1) reliability, (2) construct validity, (3) convergent validity by comparing FCU Online Assessment subscales to similar parenting and child behavior measures, and (4) predictive validity by using FCU Online Assessment at pretest to predict posttest scores as well as parenting and child behaviors at time 2 and time 3. Results: Strong reliability was found among all five subscales, including Low Conflict (7 items, α = .81), Positive Parenting Practices (11 items, α = .80), Positive School Behaviors (5 items, α = .83), Consistent Rules and Routines (11 items, α = .81), and Child Mental Health (5 items, α = .80). The FCU Online Assessment demonstrated construct and convergent validity, as well as predictive validity in that the FCU Online Assessment at pretest predicted posttest scores. Conclusions: The FCU Online Assessment is a brief, reliable, and valid measure of parenting and child wellbeing. It can be used by parents and providers alike to evaluate parenting skills and child mental health, develop targeted goals and intervention approaches, and assess family wellbeing over time.