Medical-legal partnerships to prevent evictions and homelessness among veterans

医疗法律合作防止退伍军人被驱逐和无家可归

• 批准号: 10311660
• 负责人: Marc I Rosen
• 金额: --
• 依托单位: VA CONNECTICUT HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-11-01 至 2025-10-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10311660
• 关键词: Address; Attention; Caring; Communities; Community Integration; Complement; Complex; Connecticut; Control Groups; Country; Criminal Justice; Data; Disputes; Enrollment; Face; Fostering; Foundations; Funding; Goals; Health; Healthcare Systems; Homelessness; Housing; Impairment; Income; Intervention; Interview; Investments; Leadership; Legal; Legal Intervention; Legal Status; Legal system; Light; Low income; Measures; Mediation; Mediator of activation protein; Medical; Medical Assistance; Medical Care Team; Medical center; Mental Health; Mental Health Services; Mental disorders; Methods; Modeling; Movement; Observational Study; Outcome; Participant; Patient-Centered Care; Positioning Attribute; Provider; Quality of life; Randomized; Randomized Controlled Trials; Recovery; Rehabilitation therapy; Reporting; Research; Research Design; Risk; Services; Severities; Site; Surveys; Symptoms; Testing; Time; Uncontrolled Study; Veterans; Work; base; court; effective intervention; effectiveness evaluation; empowerment; experience; follow-up; health care delivery; health service use; healthcare community; improved; innovation; interest; multidisciplinary; patient population; payment; prevent; primary outcome; psychosocial; psychotic symptoms; randomized trial; rehabilitation service; response; secondary analysis; secondary outcome; social health determinants; social integration; symptomatology; treatment group; treatment response

Background: Medical-legal partnerships (MLPs) represent an innovative intervention that integrates legal providers into healthcare teams to address complex problems and support the rehabilitation of vulnerable patient populations. In the MLP intervention, community legal providers partner with VA facilities to provide legal assistance to homeless and at-risk veterans. MLP staff can help veterans by negotiating with landlords, setting up alternative payment plans, and representing them in eviction court which may ultimately improve Veterans’ social integration and quality of life. Our group completed a 2-year uncontrolled study of VA MLPs and found that veterans showed significant improvements in housing, income, and mental health after receiving MLP services. A more rigorous research design is proposed as a next step in evaluating VA MLPs and their effect on the rehabilitation of veterans. Objectives: This project has two major aims: 1) evaluate the impact of MLP on housing outcomes (primary) and mental health outcomes (secondary); and 2) examine the veteran experience with seeking and receiving assistance from MLP and outside legal providers. Methods: For Aim 1, a randomized controlled trial of the MLP intervention for Veterans with housing-related issues (i.e., rent-based evictions, rule violations, landlord-tenant disputes) will be conducted. The study site will be the VA Connecticut Healthcare System, where the MLP intervention will be provided in partnership with the Connecticut Veterans Legal Center. A total of 300 homeless and at-risk veterans will be randomly assigned to either the MLP intervention or referral to an outside legal provider. Veterans in both groups will be assessed at baseline, 3, 6, and 12 months on housing, mental health, and various psychosocial measures. The primary outcome will be housing status and a secondary outcome will be mental health. Exploratory analyses will be conducted on outcomes such as financial status, legal status, social integration and citizenship, and quality of life. For Aim 2, a total of 30 veterans participating in the randomized controlled trial (15 participants each from the treatment and control groups) will be interviewed to collect qualitative data on their experiences receiving the MLP intervention or outside legal services. Significance: The VA is committed to preventing and ending veteran homelessness. While considerable efforts have been made to house veterans, services are needed to help them sustain housing and community integration. Numerous reports and surveys indicate that legal assistance for civil legal problems is a major unmet need among homeless and at-risk veterans. VA MLPs offer an opportunity to help veterans address housing-related issues, which could prevent homelessness and assist their rehabilitation. The MLP intervention is consistent with the VA’s comprehensive continuum of rehabilitative services for veterans and the movement towards multidisciplinary, integrated care to address social determinants of health. This project will provide needed data on VA MLPs and help inform decisions about the expansion of MLPs across the country for homeless and at-risk veterans.

背景：医疗-法律伙伴关系是一种创新的干预措施， 医疗服务提供者进入医疗保健团队，以解决复杂的问题，并支持弱势群体的康复 患者人群。在MLP干预中，社区法律的提供者与VA设施合作， 向无家可归和处境危险的退伍军人提供法律的援助。MLP的工作人员可以通过与房东谈判来帮助退伍军人， 制定替代付款计划，并在驱逐法庭上代表他们，最终可能会改善 退伍军人的社会融合和生活质量。我们的小组完成了一项为期2年的非对照研究VA MLP 发现退伍军人在住房，收入和心理健康方面都有显着改善， 获得MLP服务。一个更严格的研究设计提出了下一步评估VA MLPs 以及它们对退伍军人康复的影响。 目标：该项目有两个主要目标：1）评估MLP对住房结果的影响（主要） 和心理健康结果（次要）;和2）检查退伍军人的经验，寻求和接受 MLP和外部法律的提供者的协助。 方法：针对目标1，对退伍军人进行MLP干预的随机对照试验， 问题（即，租金驱逐、违反规则、房东与房客之间的纠纷）。研究中心将 是弗吉尼亚州康涅狄格州医疗保健系统，其中MLP干预将提供与合作伙伴关系， 康涅狄格退伍军人法律的中心。共有300名无家可归和处境危险的退伍军人将被随机分配到 MLP干预或转介给外部法律的提供者。两组的退伍军人将在 基线，3，6和12个月的住房，心理健康和各种心理社会措施。主 结果将是住房状况，次要结果将是心理健康。探索性分析 根据财务状况、法律的地位、社会融合和公民身份以及 生活对于目标2，共有30名退伍军人参加了随机对照试验（15名参与者来自 治疗组和对照组）将接受访谈，以收集有关其接受 MLP干预或外部法律的服务。 意义：退伍军人事务部致力于防止和结束退伍军人无家可归。虽然数量可观， 为退伍军人提供住房已经做出了努力，需要提供服务，帮助他们维持住房和社区 一体化许多报告和调查表明，对民事法律的问题的法律的援助是一个主要的 无家可归和处境危险的退伍军人的需求得不到满足。VA MLP提供了一个帮助退伍军人解决 与住房有关的问题，这可以防止无家可归，并协助他们康复。MLP干预 符合退伍军人事务部为退伍军人和运动提供的全面的康复服务 实现多学科、综合护理，以解决健康的社会决定因素。本项目将提供 需要关于VA MLPs的数据，并帮助为全国范围内MLPs的扩展决策提供信息， 无家可归和处境危险的退伍军人