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名退伍军人被监禁在监狱或监狱中，另有数千人被捕， 参与法庭审判，或缓刑或假释每年。这些“正义参与的退伍军人”有广泛的 医疗和精神健康障碍、住房不稳定以及自杀和其他死亡风险增加。 自2007年以来，退伍军人健康管理局（VHA）一直在运作退伍军人司法计划（VJP）， 为地方法院、监狱和司法部门的退伍军人提供外展、评估和案件管理， 监狱，并与刑事司法伙伴联络。在2018财年，VJP为80，653人提供了服务 老兵关于VJP服务和退伍军人结果之间联系的研究受到缺乏 评估自愿参与方案结构、进程和成果的系统方法。VJP和以退伍军人为重点的犯罪 司法倡议继续实施新的功能，而没有必要的工具来衡量，描述， 评估其组成部分。要为项目规划和资源分配提供信息， 结构和程序与参与司法的退伍军人的更好结果有关。本解释性 顺序混合方法研究将开发VJP计划评估仪表板，以确定VJP中的差距 以及为涉及司法的退伍军人提供的VHA服务。通过使用此仪表板，VJP领导者可以制定策略 和实践，以改善医疗保健，住房和死亡率的结果之间的司法参与退伍军人。 意义/影响：鉴于精神健康障碍、无家可归和死亡率的风险增加， 由于涉及退伍军人，VHA必须提供服务，以满足这一人群的需求。这 研究响应VA优先事项，为退伍军人提供有效和高效的护理，退伍军人治疗法院 立法，研究与发展办公室的优先事项，以增加现实世界的影响，研究，HSR&D 精神健康治疗和健康公平的优先事项，以及VJP优先事项，以最大限度地提高成功的结果 参与司法的退伍军人 创新：VJP处于与非VHA刑事司法和社区机构合作的最前沿， 为参与正义的退伍军人服务该项目通过检查VJP/非- VHA伙伴关系和吸取的教训，可以适用于退伍军人谁接受VHA以外的服务。 具体目标：这三个目标在科学上都很重要，反映了参与司法的广泛投入。 退伍军人和VJP领导人和工作人员：（1）确定退伍军人，VJP，VHA设施和刑事司法因素， 预测医疗保健，住房和无家可归的服务，以及涉及司法的退伍军人的死亡率结果;（2） Qualitative评估退伍军人和其他关键利益相关者对成功因素的看法 涉及司法的退伍军人的医疗保健，住房和死亡率结果;（3）制定一项计划 VJP服务的评估仪表板，VHA资源，以及影响司法参与的刑事司法因素 退伍军人的成果。 方法：本研究以弱势群体行为模式为指导。在目标1中，我们 对设施进行具有随机效应的多级回归模型，以检查退伍军人、VJP、VHA设施， 和刑事司法因素与成功的结果之间的司法参与退伍军人（n=80,653， FY18）。对于目标2，我们将对32名参与司法的退伍军人和48名VHA进行定性访谈， 8个VHA设施和伙伴机构的刑事司法工作人员（n=80）。目标3将是开发和试点测试 （n=14）方案评价仪表板，以查明服务差距并为政策和做法提供信息。 实施/下一步：结果将立即对VJP，国家中心， 无家可归的退伍军人，和VHA优先考虑和定制卫生服务，以公正参与退伍军人， 最大限度地提高效益，并用于制定干预措施，以改善司法所涉的健康和医疗保健 将在随后的IIR中进行评估的退伍军人。