Testing implementation support strategies to facilitate an evidence-based substance use and mental health care intervention in veterans treatment courts

Plain English summary of protocol

Background and study aims
Veterans Treatment Courts (VTCs) were established in 2004 to address the needs of justice-involved Veterans and reduce prison overcrowding. With over 500 VTCs nationally, they offer Veterans an alternative to incarceration and an opportunity to address their behavioral health needs in lieu of jail or prison. Despite the success of VTCs, care can become fragmented between VTCs and VA behavioral health and social programs, particularly for those with multiple service needs. This is often true for justice-involved Veterans with co-occurring MH and SUD, as they make up 60% of VTC cases, and frequently have difficulty engaging in MH and SUD treatment, which often results in a spiraling into unemployment and homelessness, which are themselves strong predictors of reoffending. The VA Veterans Justice Outreach (VJO) Program serves the VTCs and delegates a Veterans Justice Outreach Specialist to the court, who has the responsibility of linking eligible Veterans to VA addiction and other behavioral health services. While VJO has shown great success, high risk clients in VTCs, particularly those with co-occurring disorders could benefit from comprehensive wraparound services to help the Veteran remain engaged in VA and NON-VA care.

Maintaining Independence and Sobriety through Systems Integration, Outreach and Networking - Criminal Justice version (MISSION-CJ) includes a structured wraparound treatment approach delivered by case managers (CMs) and peer specialists (PS), who offer justice involved Veterans with mental health and substance use disorder group psychoeducational therapy sessions, outreach, and linkage support for 6 months. The core MISSION-CJ treatment elements, include: (1) Critical Time Intervention (CTI) (CM and PS deliver assertive outreach); (2) Empowering Prosocial Change (6 structured group sessions for Veterans Treatment Court Participants that promote prosocial thinking and behavior); (3) Dual Recovery Therapy (DRT) (13 weekly structured group sessions delivered by CMs to address MH and SUD problems and modify antisocial cognitions & behaviors); (4) Peer Support Sessions (11 structured group sessions delivered by PSs to reinforce prosocial behavior engagement, and modify antisocial cognitions and behaviors); and (5) Linkage to employment and trauma services as needed (CM/PS facilitate linkages).

In 2016, MISSION was entered into the Substance Abuse and Mental Health Services Administration National Registry of Evidence-Based Programs and Practices. Because of the significant overlap between criminal justice and homelessness among the Veteran population, we modified MISSION, now called MISSION-Criminal Justice (MISSION-CJ) to meet the criminal justice needs of Veterans. We conducted four studies of MISSION-CJ, two in Veterans Treatment courts, one in a mental health court and one in a drug court. These studies demonstrated that participants in MISSION-CJ showed improvements in criminal recidivism, mental health and substance abuse outcomes, employment and optimized linkages to VA and non-VA care. Given these promising results of MISSION and the adaption of criminal justice, an important next step is to identify the most effective implementation strategy, and to work on developing a cost and business case analysis to help with spread and sustainability in VA.

Project Aims:
Aim 1: Identify pre-implementation barriers and facilitators to adopting MISSION-CJ across sites.
Aim 2: Conduct a stepped wedge trial to determine the successful implementation of an educational outreach vs. facilitation.
Aim 3: Develop an implementation Playbook to support sustainment of MISSION-CJ in VTCs.

Who can participate?
Veterans justice outreach specialists and peer support specialists working with Veterans treatment courts, and veterans with substance use disorder and another mental health disorder.

What does the study involve?
This will be a hybrid type III effectiveness-implementation trial utilizing an adaptive design. First, all sites will be trained on MISSION-CJ. Second, a low intensity educational outreach baseline implementation strategy will be offered to help sites deliver MISSION-CJ. Third, every six months, two sites will add on implementation facilitation (higher intensity implementation strategy that includes technical assistance) for 12 months. This design allows us to examine the uptake of MISSION-CJ utilizing educational outreach or implementation facilitation and increased access and engagement in VA/Non-VA care and reduce criminal recidivism among the clients being served be staff delivering MISSION-CJ.

What are the possible benefits and risks of participating?
Benefits of participation include adhering to an evidence-based practice with more fidelity to the model, as well as an opportunity to provide veterans an evidence-based practice to enhance their treatment.
No risks are expected.

Where is the study run from?
VA Bedford Health Care (USA)

When is the study starting and how long is it expected to run for?
October 2020 to December 2025

Who is funding the study?
U.S. Department of Veterans Affairs

Who is the main contact?
Dr David Smelson, david.smelson@va.gov

Contact information

Dr David Smelson
Principal Investigator

VA Bedford Healthcare System
Center for Healthcare Organization and Implementation Research (CHOIR)
200 Springs Road (152)
Bedford
01730
United States of America

ORCID ID	0000-0001-9161-9818
Phone	+1 781-825-7778
Email	david.smelson@va.gov

Study information

Eligibility

Locations

Countries of recruitment

• United States of America

Study participating centres

Sponsor information

Funders

Funder type

Government

Results and Publications

Editorial Notes

21/12/2022: Trial's existence confirmed by Department of Veterans Affairs.