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: 10595495
• 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/10595495
• 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; 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中，另有数千人被捕， 每年在法庭上，或在缓刑或假释期间。这些“牵涉正义的退伍军人”有着广泛的 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)一直在运营退伍军人司法方案(VJP)，以 为当地法院、监狱和监狱中涉及司法的退伍军人提供外联、评估和案件管理 与监狱合作，并与刑事司法合作伙伴联络。2018财年，VJP为80653人提供了服务 退伍军人。VJP服务和退伍军人结果之间的联系的研究因缺乏 评估合作伙伴关系结构、过程和结果的系统方法。VJP和以老兵为中心的罪犯 司法部计划继续实施新功能，但没有衡量、描述和 评估它们的组成部分。要为计划规划和资源分配提供信息，必须了解哪些 结构和进程与参与司法的退伍军人获得更好的结果有关。此说明性说明 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 以及为涉及正义的退伍军人提供的VHA服务。通过使用此仪表板，越共领导人可以制定政策 和做法，以改善涉及司法的退伍军人的医疗保健、住房和死亡率结果。 意义/影响：鉴于精神健康障碍、无家可归和司法死亡率的风险增加- 对于涉及的退伍军人，VHA必须提供服务，以满足这些人口的需求。这 研究回应退伍军人管理局优先事项，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，研发办公室优先增加研究、高铁和研发的现实影响 心理健康治疗和健康公平的优先事项，以及为最大限度地取得成功而设立的人民军优先事项 在涉及正义的退伍军人中。 创新：VJP处于与非VHA刑事司法和社区机构合作的前沿 为涉及正义的退伍军人服务。该项目通过研究VJP/非VJP VHA伙伴关系和吸取教训，可适用于在VHA以外接受服务的退伍军人。 具体目标：这三个目标具有重要的科学意义，反映了司法的广泛投入 退伍军人和VJP领导人和员工：(1)确定退伍军人、VJP、VHA设施和刑事司法因素 预测医疗保健、住房和无家可归服务，以及涉及司法的退伍军人的死亡结果；(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看法 涉及正义的退伍军人的医疗保健、住房和死亡结果；以及(3)制定一个计划 VJP服务、VHA资源和影响司法的刑事司法因素的评价仪表板-涉及 经验丰富的结果。 研究方法：本研究以弱势人群行为模型为指导。在目标1中，我们将 对设施进行具有随机效应的多水平回归模型，检验退伍军人、VJP、VHA设施、 以及与参与司法的退伍军人取得成功结果有关的刑事司法因素(#年为80,653人 18财年)。对于目标2，我们将对32名涉及司法的退伍军人和48名VHA和 8个志愿人员协会设施和伙伴机构的刑事司法工作人员(n=80)。目标3将是开发和试运行 (n=14)一个计划评估仪表板，用于确定服务差距并为政策和实践提供信息。 执行/下一步：结果将对VJP，国家中心 退伍军人中的无家可归者，以及VHA优先考虑并为涉及司法的退伍军人量身定做卫生服务，以 最大限度地提高利益，并用于制定干预措施，以改善司法相关人员的健康和保健 将在随后的IIR中进行评估的退伍军人。