Evaluating Health Services for Justice-Involved Veterans to Improve Policy and Practice

评估参与司法的退伍军人的健康服务，以改进政策和实践

• 批准号: 10315010
• 负责人: Andrea K Finlay
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2025-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10315010
• 关键词: Address; Behavioral Model; Caring; Case Management; Characteristics; Communities; Complex; Criminal Justice; Crisis Intervention; Data; Disease; Effectiveness; Goals; Health; Health Services; Health Services Administration; Healthcare; Homelessness; Housing; Imprisonment; Intervention; Interview; Jail; Justice; Knowledge; Link; Measures; Medical; Mental Health; Mental disorders; Methodology; Methods; Modeling; Monitor; Outcome; Personal Satisfaction; Police; Policies; Population; Predictive Factor; Prisons; Process; Program Evaluation; Psyche structure; Research; Research Personnel; Residential Treatment; Resource Allocation; Resources; Risk; Sampling; Services; Specialist; Statutes and Laws; Structure; System; United States Health Resources Administration; Veterans; Veterans Health Administration; Visit; Vulnerable Populations; court; dashboard; health equity; housing instability; improved; improved outcome; innovation; mortality; mortality risk; operation; outreach; parole; pilot test; probation; programs; recruit; research and development; residence; service gap; service programs; stakeholder perspectives; suicidal risk; tool

Background: An estimated 181,500 veterans are incarcerated in prison or jail with thousands more arrested, involved in courts, or on probation or parole each year. These “justice-involved Veterans” have extensive medical and mental health disorders, housing instability, and an elevated risk for suicide and other mortality. Since 2007, the Veterans Health Administration (VHA) has operated the Veterans Justice Programs (VJP) to provide outreach, assessment, and case management for justice-involved Veterans in local courts, jails, and prisons, and to liaise with criminal justice partners. In fiscal year 2018, VJP provided services to 80,653 Veterans. Research on the link between VJP services and Veteran outcomes is hindered by a lack of systematic methods to assess VJP structures, processes and outcomes. VJP and Veteran-focused criminal justice initiatives continue to implement new features without the tools needed to measure, describe, and evaluate their components. To inform program planning and resource allocation, it is essential to know which structures and processes are linked to better outcomes for justice-involved Veterans. This explanatory sequential mixed methods study will develop a VJP program evaluation dashboard to determine gaps in VJP and VHA services for justice-involved Veterans. By using this dashboard, VJP leaders can develop policies and practices to improve healthcare, housing and mortality outcomes among justice-involved Veterans. Significance/Impact: Given the elevated risk mental health disorders, homelessness, and mortality for justice- involved Veterans, it is imperative that VHA provides services to address the needs of this population. This study responds to VA priorities to deliver effective and efficient care to Veterans, Veterans Treatment Court legislation, the Office of Research & Development priority to increase real-world impact of research, HSR&D priorities of mental health treatment and health equity, and the VJP priority to maximize successful outcomes among justice-involved Veterans. Innovation: VJP is at the forefront of partnering with non-VHA criminal justice and community agencies to serve justice-involved Veterans. This project breaks new ground by examining the full continuum of VJP/non- VHA partnerships and drawing lessons that can be applied to Veterans who receive services outside VHA. Specific Aims: The three aims are scientifically important and reflect extensive input from justice-involved Veterans and VJP leaders and staff: (1) Identify Veteran, VJP, VHA facility, and criminal justice factors that predict healthcare, housing and homeless services, and mortality outcomes for justice-involved Veterans; (2) Qualitatively evaluate Veterans’ and other key stakeholders’ perspectives of factors that explain successful healthcare, housing, and mortality outcomes among justice-involved Veterans; and (3) Develop a program evaluation dashboard of VJP services, VHA resources, and criminal justice factors that impact justice-involved Veteran outcomes. Methodology: The current study is guided by Behavioral Model for Vulnerable Populations. In Aim 1, we will conduct multi-level regression models with a random effect for facility, to examine Veterans, VJP, VHA facility, and criminal justice factors associated with successful outcomes among justice-involved Veterans (n=80,653 in FY18). For Aim 2, we will conduct qualitative interview with 32 justice-involved Veterans and 48 VHA and criminal justice staff at 8 VHA facilities and partner agencies (n=80). Aim 3 will be to develop and pilot-test (n=14) a program evaluation dashboard to identify service gaps and inform policy and practice. Implementation/Next Steps: Results will be of immediate value to VJP, the National Center on Homelessness Among Veterans, and VHA to prioritize and tailor health services to justice-involved Veterans to maximize benefit and used to develop interventions to improve the health and healthcare of justice-involved Veterans that will be evaluated in a subsequent IIR.

背景：估计有181,500名退伍军人在监狱或监狱中被监禁，数千人被捕， 每年涉及法院，缓刑或假释。这些“参与正义的退伍军人”有广泛的 医疗和心理健康障碍，住房不稳定以及自杀和其他死亡的风险升高。 自2007年以来，退伍军人卫生管理局（VHA）已运营退伍军人司法计划（VJP） 在地方法院，监狱和 监狱，并与刑事司法伙伴联络。在2018财年，VJP为80,653提供服务 退伍军人。 VJP服务与退伍军人成果之间的联系的研究阻碍了 评估VJP结构，过程和结果的系统方法。 VJP和以资深人士为中心的罪犯 司法倡议继续实施新功能，而无需衡量，描述和 评估其组件。为了告知计划计划和资源分配，必须知道哪个 结构和过程与涉及正义的退伍军人的更好结果有关。这种解释性 顺序混合方法研究将开发VJP程序评估仪表板，以确定VJP中的差距 和VHA服务为涉及正义的退伍军人。通过使用此仪表板，VJP领导者可以制定政策 以及改善涉及正义的退伍军人的医疗保健，住房和死亡率的实践。 显着性/影响力：鉴于风险升高的心理健康障碍，无家可归和正义死亡率的升高 - 涉及退伍军人，VHA必须提供服务以满足该人群需求的服务。 研究对VA的优先事项做出回应，以向退伍军人，退伍军人治疗法院提供有效和有效的护理 立法，研究与开发的优先事项，以增加研究的实际影响，霍斯和D 心理健康治疗和健康平等的优先事项以及VJP优先事项，以最大程度地提高成功结果 在参与正义的退伍军人中。 创新：VJP与非VHA刑事司法和社区机构合作的最前沿 为涉及正义的退伍军人服务。该项目通过检查VJP/非 - VHA合作伙伴关系和绘画课程，可以应用于在VHA以外获得服务的退伍军人。 具体目的：这三个目标在科学上很重要，并反映了涉及正义的广泛投入 退伍军人和VJP领导人和工作人员：（1）确定退伍军人，VJP，VHA设施以及刑事司法因素 预测涉及正义的退伍军人的医疗保健，住房和无家可归的服务以及死亡率； （2） 定性评估退伍军人和其他关键利益相关者对解释成功的因素的观点 涉及正义的退伍军人的医疗保健，住房和死亡率； （3）制定程序 VJP服务，VHA资源和刑事司法因素的评估仪表板影响司法涉及司法 资深结果。 方法论：当前的研究以脆弱人群的行为模型为指导。在AIM 1中，我们将 进行多级回归模型对设施具有随机效果，检查退伍军人，VJP，VHA设施， 以及与司法诉讼的退伍军人成功取得成功相关的刑事司法因素（n = 80,653 FY18）。对于AIM 2，我们将对32名与正义的退伍军人和48 VHA进行定性采访 8 VHA设施和合作伙伴机构的刑事司法人员（n = 80）。 AIM 3将是开发和进行试验测试 （n = 14）一个程序评估仪表板，以识别服务差距并为政策和实践提供信息。 实施/下一步：结果将对国家中心VJP立即价值 退伍军人之间的无家可归，VHA将卫生服务优先和量身定制为司法官员的退伍军人 最大化福利，并用于制定干预措施，以改善涉及正义的健康和医疗保健 将在随后的IIR中进行评估的退伍军人。